This is a comprehensive MSRA guide that covers everything you need to know: what the exam actually tests, how it's scored, which specialties use it and why, and exactly how to prepare so you give yourself the best possible chance of a competitive score. We created this guide because information available elsewhere can often be fragmented, outdated, or difficult to find across multiple sources. Recruitment rules evolve, scoring details can sometimes be misunderstood, and candidates deserve clear, reliable information when making important career decisions. Everything here is verified against current national recruitment guidance and updated every cycle. If something changes, this page changes with it.
The Multi-Speciality Recruitment Assessment (MSRA) is a 170-minute, computer-based exam used to shortlist and rank candidates for entry into ST1 and CT1 speciality training across a growing number of UK programmes. It tests applied clinical knowledge and professional judgement, and its content maps directly to the UK Foundation Programme Curriculum and the GMC's Generic Professional Capabilities framework.
With competition ratios climbing year on year (clinical radiology sat at roughly 11 applicants per post in 2025, obstetrics and gynaecology at nearly 17, and core psychiatry above 21), the MSRA increasingly acts as the first hard filter on an application, often deciding who reaches interview before a single interviewer is involved.
The MSRA has two sections, sat in a single sitting at a Pearson VUE test centre:
The situational judgement paper uses ranking questions and "select the three most appropriate" questions to explore judgment, decision-making, and ethical reasoning — aligned with the GMC's Good Medical Practice guidance rather than clinical knowledge.
Tests clinical knowledge and judgement across a broad range of medical topics using Single Best Answer questions with five options, alongside Extended Matching Questions with eight options.
For many candidates, the MSRA score is one of the most important parts of their application. It is used across a growing number of specialties to help shortlist and rank applicants for specialty training, including:
In some programmes, a strong MSRA score can lead to a direct offer without the need for an interview, as is the case in general practice and psychiatry. In more competitive specialties the score often determines who moves forward to the next stage, and where programmes use a combined ranking approach, your MSRA result contributes directly to your overall application score.
Put simply, the MSRA can be a deciding factor in your application. A lower score may limit your options early on, while a strong performance can significantly improve your chances of progressing.
The MSRA has become a key part of recruitment for an increasing number of specialties. The table below shows which programmes use the exam and how much weight your score carries in the application process.
| Specialty | Interview Required? | How MSRA is Used | Impact on Application |
|---|---|---|---|
| GP ST1 | No interview | Ranking only | Your MSRA score makes up 100% of your ranking and determines your offer and location allocation. |
| Core Psychiatry CT1 | No interview | Ranking only | Your MSRA score determines ranking. You must achieve at least 186 (raw score) in each paper to be appointable. |
| O&G ST1 | Yes, unless direct offer | Shortlisting + final ranking | The top 75 nationally receive direct offers. For interview candidates, the MSRA contributes 33.33% of the final score. |
| Clinical Radiology ST1 | Yes | Shortlisting only | Used for interview selection. Final ranking is based on portfolio (~30%) and interview (~70%). |
| Core Surgical Training CT1 | Yes | Shortlisting + final ranking | Helps select interview candidates and contributes 10% of the final score. |
| Ophthalmology ST1 | Yes | Shortlisting only | Does not contribute to final ranking. Only the top 300 scorers progress to portfolio and interview. |
| ACCS Emergency Medicine CT1/ST1 | Yes | Shortlisting + final ranking | Typically weighted at 40% of the total application score, with interview contributing 60%. |
| Anaesthetics CT1 | Yes | Shortlisting + final ranking | Contributes 15% of the total selection score, with interview contributing 85%. |
| Neurosurgery ST1-ST3 | Yes | Shortlisting filter, then combined score | MSRA is combined with shortlisting/portfolio scoring. Exact weighting is not published as a fixed percentage. |
| Community Sexual and Reproductive Health (CSRH) ST1 | Yes | Shortlisting filter | MSRA determines interview eligibility. Final selection relies mainly on interview and portfolio performance. |
| Nuclear Medicine ST3 | Yes | Shortlisting filter, then combined score | MSRA is used for interview selection and contributes to the final ranking. |
You cannot register for the MSRA yourself. Invitations are sent automatically through Oriel once you have passed the longlisting stage, and you will then book your assessment slot directly through Pearson VUE.
There are two MSRA assessment windows each year:
Remote testing through OnVUE is available only in specific circumstances. Check the latest guidance from the official medical recruitment site before assuming you are eligible.
The MSRA is completely free to sit — there are no registration fees, booking costs, or hidden charges. The one thing to budget for is getting there: travel, accommodation, or food costs are not reimbursable.
The paper uses two question types: Ranking (rank 4–5 possible actions from most to least appropriate, no tied ranks allowed) and Multiple choice (select the 3 most appropriate actions from a list of 8).
It assesses three core competencies: professional integrity, coping with pressure, and empathy and sensitivity. The scenarios typically draw on five ethical domains:
This is a situational judgement test rooted firmly in the GMC's Good Medical Practice, not a test of advanced clinical knowledge.
Extended Matching Questions (EMQs) provide a list of 8 possible response options applied across multiple independent clinical scenarios. Single Best Answer (SBA) questions present a scenario followed by 5 possible answers.
Questions are drawn from 12 core clinical topic areas, including cardiovascular, dermatology/ENT/eyes, endocrinology, gastroenterology, infectious disease, musculoskeletal, paediatrics, pharmacology, psychiatry & neurology, renal & urology, reproductive health, and respiratory. The content is based on current clinical guidance, including sources such as NICE and the BNF.
Across these topics, the CPS paper tests five key clinical domains:
The CPS paper, unlike the PD Paper, includes 11 unscored pilot questions within the total of 97 questions. These questions are used by examiners to test and evaluate potential future exam items, but they are mixed into the paper and are completely indistinguishable from scored questions. You will not know which questions are pilots during the exam, so treat every question as if it contributes to your final score. If you come across a question that feels unusually difficult or unfamiliar, do not spend excessive time trying to solve it. Make your best judgment, select an answer, and move on.
The two papers are scored separately: CPS gives 1 mark per correct answer with no negative marking, so guessing is mathematically worthwhile. PD is scored against an expert consensus key, with partial credit based on how closely your ranking matches the master answers.
Raw scores are normalised, typically centred around a mean of 250 with a standard deviation of 40, and divided into Bands 1 to 4.
Scores above 250 already place you ahead of most candidates, and anything above 290 is rare. Because banding is relative to your cohort, your goal is simply to score as high as you can against everyone else sitting in that window.
| Standardised score | Band | Meaning | CPS (% in range) | PD (% in range) |
|---|---|---|---|---|
| Below 185 | 1 | Very poor | 14% | 23% |
| 186-230 | 2 | Below average | 27% | 51% |
| 231-290 | 3 | Good | 42% | 25% |
| Above 290 | 4 | Very good | 3% | 1% |
There is no single MSRA score that guarantees success. Your result is calculated against the performance of your cohort, so what counts as a "good" score can change each year.
As a general guide:
Your MSRA score plays the biggest role because candidates are ranked directly by their exam performance.
A strong score can help you clear shortlisting and reach interview; every additional point can strengthen your overall position where the exam also contributes to final ranking.
Small differences in MSRA scores can have a significant impact on ranking. The best approach is not to aim for a specific "magic number", but to maximise your score. A few extra marks can make the difference between progressing, securing an offer, or having more choice in where you train.
The MSRA is challenging because it covers a broad range of medicine, from diagnosis and investigations to management and prescribing. You need a strong foundation across common clinical presentations and up-to-date guideline knowledge, including NICE guidance.
For many candidates, the hardest part is not the complexity of individual questions but the pace of the exam — recognising patterns, making decisions quickly, and moving on is just as important as knowing the content.
Your score is compared against other applicants sitting the same assessment window, so preparation is less about memorising obscure facts and more about building confidence, accuracy, and speed through consistent practice.
A score is only valid for the specific recruitment year in which you sit it. You can take the MSRA as many times as you wish throughout your career, provided you are eligible to apply for a specialty that uses the exam. However, you can only sit the MSRA once during each recruitment round (sitting), and that score will be used for all specialties you apply to within that round. There is one nuance within a single recruitment year: if you apply across different rounds in the same year, some specialties allow you to carry your score forward from an earlier sitting, while others require a fresh attempt. The rules vary by specialty, so always check the relevant recruitment guidance before assuming your score will carry over.
There is no single revision schedule that works for everyone, but most successful candidates build their preparation gradually: first by understanding the exam and filling knowledge gaps, then by moving into timed practice and exam technique.
Get familiar with both papers and identify where you need the most work. For CPS, begin with high-yield areas such as cardiology respiratory medicine, gastroenterology, and endocrinology. For PD, focus on patient safety, confidentiality, consent, escalation, and professionalism.
Shift more of your time towards timed practice. Work through larger question sets and start completing full mock papers to build pace and stamina, and use your results to focus on topics where you consistently lose marks.
Refine your exam technique rather than trying to learn every possible topic. Complete timed mocks, review your errors, and revisit high-yield areas such as first-line management, red flags, and common PD scenarios. Avoid last-minute cramming.
A good MSRA revision plan should follow a SMART approach: set goals that are specific, measurable, achievable, relevant, and time-bound.
In March 2026, a significant change to how NHS training posts are allocated became law. The Medical Training (Prioritisation) Act 2026 received Royal Assent on 5 March 2026, having been fast-tracked through Parliament as emergency legislation, and applies across all four UK nations.
The Act requires that training posts at specialty level are offered first to a defined "priority group" before any remaining places are offered to other applicants, introduced in response to a sharp rise in competition: applications for specialty training have grown from around 12,000 in 2019 to nearly 40,000 for the 2026 cycle.
International medical graduates outside these groups can still apply — they simply receive any offers after prioritised applicants have been placed.
The two papers are scored separately and normalised into Bands 1 to 4, typically centred around a mean of 250 with a standard deviation of 40.
There is no fixed target — scores are relative to your cohort. As a general guide, 520+ is competitive and 580+ is exceptional.
Yes, as many times as you wish across your career, but only once per recruitment round — that score is used for every specialty you apply to within that round.
It covers a broad range of medicine at pace rather than obscure detail — most candidates find the time pressure harder than the individual questions.
Practise with the UK MSRA question bank trusted by thousands of candidates.