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 We created this guide because information available elsewhere can often be fragmented, outdated, or difficult to find across multiple sources.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 contains around 50 scenarios designed to assess how candidates approach professional challenges. It uses ranking questions and “select the three most appropriate” questions to explore judgment, decision-making, and ethical reasoning.
Rather than testing clinical knowledge, it focuses on professionalism, values, and how you would respond as a doctor in pressured situations, aligned with the GMC’s Good Medical Practice guidance.
The CPS paper contains around 97 questions designed to test clinical knowledge and judgement across a broad range of medical topics. It uses Single Best Answer questions with five options, alongside Extended Matching Questions with eight options. The content is based on current clinical guidance, including sources such as NICE and the BNF.
For many candidates, the MSRA score is one of the most important parts of their application. The reason it carries so much weight is that it is used across a growing number of specialties to help shortlist and rank applicants for specialty training, including:
The MSRA has become a key part of recruitment for an increasing number of specialties. Find out below which programmes use the exam and how much weight your score carries in the application process.
*Recruitment processes are reviewed regularly and can change between cycles. The weightings and requirements below reflect the current recruitment round only, and scoring thresholds, direct offer routes, and which specialties use the MSRA may be updated in future. Always check the latest official national recruitment guidance for your chosen specialty before planning your application strategy.
| 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 | All candidates sit the MSRA. The top 75 nationally receive direct offers. For candidates invited to interview, the MSRA contributes 33.33% of the final score. |
| Clinical Radiology ST1 | Yes | Shortlisting only | MSRA is used for interview selection. Final ranking is based on portfolio (around 30%) and interview performance (around 70%). |
| Core Surgical Training (CST) CT1 | Yes | Shortlisting + final ranking | MSRA helps select interview candidates and contributes 10% of the final score. Interview stations make up the remaining 90%. |
| Ophthalmology ST1 | Yes | Shortlisting only | MSRA does not contribute to the final ranking. Only the top 300 scorers progress to portfolio scoring and interview. |
| ACCS Emergency Medicine CT1/ST1 | Yes | Shortlisting + final ranking | MSRA is typically weighted at 40% of the total application score, with interview contributing 60%. |
| Anaesthetics CT1 | Yes | Shortlisting + final ranking | MSRA 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.
Once your invitation arrives, it is best to book your slot as soon as possible. Places at physical Pearson VUE test centres are limited and can fill quickly during the short assessment window, meaning waiting a few days could leave you with fewer options for location or date.
There are two MSRA assessment windows each year:
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. Any travel, accommodation, or food costs you incur to reach your test centre are not reimbursable, which is one more reason to book a local centre as soon as your invitation arrives.
The paper uses two question types:
The CPS paper uses two question formats. Extended Matching Questions (EMQs) provide a list of 8 possible response options, which are then applied across multiple independent clinical scenarios.
Single Best Answer (SBA) questions present a clinical scenario followed by 5 possible answers, requiring you to select the one option that best fits the situation.
Questions are drawn from 12 core clinical topic areas covering the breadth of medicine, including:
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: 1 mark per correct answer, with no negative marking. Guessing is mathematically worthwhile, so never leave a question blank.
PD: Scored against an expert consensus key, with partial credit awarded based on how closely your ranking matches the master answers.
Raw scores are then 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, meaning what counts as a “good” score can change each year depending on the strength of the applicant pool and the competitiveness of your chosen route.
How much your MSRA score matters depends on the discipline you are applying for
As a general guide:
Your MSRA score plays the biggest role because candidates are ranked directly by their exam performance. A higher score can improve your chances of securing your preferred deanery and location, and in some cases can lead to an offer without interview.
A strong MSRA score can help you clear the shortlisting stage and reach the interview stage. In specialties where the exam also contributes to final ranking, every additional point can strengthen your overall position.
When applicant numbers are high, small differences in MSRA scores can have a significant impact on ranking. A stronger result gives you more flexibility when choosing specialties, regions, and training locations.
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 are not expected to be an expert in every specialty, but you do need a strong foundation across the common clinical presentations and up-to-date knowledge of relevant guidelines, including NICE guidance.
For many candidates, the hardest part is not the complexity of individual questions but the pace of the exam. On the CPS paper, you have limited time to work through each scenario, so being able to recognise patterns, make decisions quickly, and move on is just as important as knowing the content.
The MSRA is also a competitive exam. Your score is compared against the performance of 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.
MSRA scores have a strict shelf life. A score is only valid for the specific recruitment year in which you sit it. There is no guarantee of a strong result for future cycles, so if you reapply in a later recruitment year, you must sit the exam again.
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.
Start by getting familiar with both papers and identifying where you need the most work. Aim for consistent practice rather than occasional long revision sessions. Completing a regular mix of CPS and PD questions will help you understand the style of the exam and highlight weaker areas early.
For CPS, begin with common high-yield areas such as cardiology, respiratory medicine, gastroenterology, and endocrinology. For PD, focus on the principles that underpin good medical practice, including patient safety, confidentiality, consent, escalation, and professionalism.
As the exam approaches, shift more of your time towards timed practice. Work through larger sets of questions and start completing full mock papers to build pace and stamina.
Use your results to identify patterns in your mistakes. Rather than revising everything again, focus on the topics and question types where you are consistently losing marks. This is also the time to revisit weaker clinical areas and consolidate key guidelines.
The final stage is about refining 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 final few weeks should leave you feeling confident with the format, comfortable with the pace, and prepared to make decisions under time pressure.
A good MSRA revision plan should also follow a SMART approach: set goals that are specific, measurable, achievable, relevant, and time-bound. Rather than setting broad targets like “revise more clinical medicine”, decide exactly what you want to complete each week, whether that is a set number of CPS questions, a specific clinical topic, or a full timed mock paper.
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. It was 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, against a largely static number of posts.
Applicants with a primary medical qualification (PMQ) from the UK or the Republic of Ireland
Applicants with a PMQ from Iceland, Liechtenstein, Norway or Switzerland
Applicants already on a relevant UK training programme (for example, foundation doctors applying for core training)
Applicants in defined immigration groups, including British and Irish citizens, those with indefinite leave to remain, and those with residence rights under the EU Settlement Scheme
International medical graduates outside these groups can still apply - they simply receive any offers after prioritised applicants have been placed.
While the Act changes the order in which offers are made, it does not change how the MSRA is scored, or the standard against which you're ranked. The exam still works exactly as described in this guide, and a competitive MSRA score remains essential whichever group you fall into.
For the 2026 specialty cycle specifically, because shortlisting was already underway when the Act passed, prioritisation is being applied at the offer stage only.