What is the MSRA?

Why it exists

Where the MSRA sits in a UK medical career

After medical school you spend two years in the Foundation Programme. Towards the end of that second year, known as F2, you apply for specialty training: the multi-year programme that eventually makes you a GP, a psychiatrist, a radiologist, a surgeon. Those applications all go through a single national portal called Oriel.

Specialties used to run their own entrance exams, which meant a candidate hedging across three specialties sat three different assessments. The MSRA replaced that with one shared exam. You sit it once, and every specialty you have applied to that requires it reads the same score.

You cannot sit the MSRA speculatively, and you cannot sit it as a medical student. You are invited to book only after you have submitted an application through Oriel to a specialty that requires it and been assessed as eligible. In practice most people sit it in the January of their F2 year, for a training post starting the following August, though plenty of applicants come to it later, after an F3 year, from a non-training post, or from overseas as an international medical graduate.

Who needs it

Which specialties require the MSRA

Eleven specialties use the MSRA as part of recruitment. If you are applying to any of these, you will sit it. If you are applying to something else, such as internal medicine training, paediatrics or histopathology, you will not.

The papers

What is actually on the exam

The MSRA is delivered as one sitting of two independently timed papers, each with its own on-screen countdown. Professional Dilemmas comes first, then an optional five-minute break, then Clinical Problem Solving. Take longer than five minutes and the overrun comes out of your CPS time.

Professional Dilemmas: a situational judgement test

PD is not a knowledge paper. It presents you with awkward professional situations and asks what you would do: a colleague who smells of alcohol, a consultant who wants you to do something you are not competent to do, a relative demanding information you cannot give. You answer throughout as an F2 doctor, in settings that range from the ward to general practice to an out-of-hours shift.

Roughly half the items ask you to rank four or five possible actions from most to least appropriate. The other half give you eight plausible actions and ask you to choose the three most appropriate to take in combination. Behind the scenarios sit three domains: professional integrity, coping with pressure, and empathy and sensitivity. Your responses are marked against a pre-determined answer key rather than by anyone's judgement on the day.

Clinical Problem Solving: applied clinical knowledge

CPS tests whether you can use clinical knowledge, not whether you can recall it. Questions put you in front of a patient and ask for the diagnosis, the next investigation, or the right management step. The expected level is foundation training: what a competent F2 should know. But the breadth is wide and the pace is punishing at roughly fifty-two seconds a question.

About half the items are extended matching questions, where one list of seven to ten options serves several linked scenarios. The rest are single best answers with five to eight options. One mark is awarded per correct response across twelve clinical areas:

• Cardiovascular
• Dermatology, ENT and eyes
• Endocrinology and metabolic
• Gastroenterology and nutrition
• Infectious disease, haematology, immunology, allergies and genetics
• Musculoskeletal
• Paediatrics
• Pharmacology and therapeutics
• Psychiatry and neurology
• Renal and urology
• Reproductive
• Respiratory

Scoring

How the MSRA is scored

This is the part most candidates get wrong, so it is worth being precise. Your raw marks are not what specialties see. Each paper's raw score is converted into a scaled score, normalised against everyone who sat that same cycle. The scale is set so that the cohort average lands on 250 with a standard deviation of 40. A score around 250 means you performed about averagely for your sitting; around 290 puts you roughly a standard deviation above it.

Because the scale is rebuilt around each cohort, NHS England is explicit that "due to the normalisation of all MSRA scores, there is no maximum achievable score". There is no total to aim at, and scores are not directly comparable between years.

Alongside the scaled score, each paper is placed in a band from 1 to 4. Band 1 means the minimum acceptable standard has not been reached, and a Band 1 in either paper makes you unsuccessful regardless of how well you did in the other. So while there is no published pass mark in the usual sense, there is a floor, and it is applied paper by paper.

Results are released through your Oriel account on a date set out in each round's recruitment timeline. The outcome is final: NHS England does not re-mark or review MSRA results and there is no appeals process.

What happens next

How specialties use your score

A single exam feeds eleven different selection processes, and they do not weigh it the same way. This matters more than most candidates realise, because it determines whether the MSRA is one factor among several or effectively the whole application.

General practice sits at one extreme. NHS England has removed the Selection Centre stage entirely: applicants are ranked nationally on MSRA performance and offers follow from that ranking, with no interview and no portfolio scoring. For GP applicants, the MSRA is the selection process.

Core psychiatry also ranks on the MSRA. Guidance sets a minimum of 186 raw marks in each paper to be considered appointable, and successful applicants can transfer their score between recruitment rounds rather than re-sitting.

Clinical radiology is a three-stage process. The MSRA decides who is invited to submit portfolio evidence and attend a two-station interview, and the final ranking combines all three. A strong MSRA gets you through the door; it does not on its own get you the post.

Core surgery, anaesthetics, obstetrics and gynaecology, ophthalmology, emergency medicine and neurosurgery broadly follow the same shape. The MSRA shortlists candidates to interview, where portfolio and interview performance then carry substantial weight. Because thresholds move each year with competition ratios and post numbers, always check the current person specification for the specialty you are applying to.

Logistics

When you sit it, where, and what it costs

There is no fee to sit the MSRA. Once your application has been assessed as eligible you are invited to book, choosing your own date, time and centre through the Pearson VUE website. NHS England delivers the exam in partnership with Work Psychology Group and Pearson VUE. It is normally taken at a test centre; remote delivery via OnVUE exists in defined circumstances, but if you live or work in the UK during the assessment window you are expected to use a UK centre.

Round 1 runs two testing windows. The first, in January, is open to applicants for every MSRA specialty. The second, in February, is reserved for Core Psychiatry and General Practice applicants only. Your window is allocated, not chosen, and it cannot be changed, even by withdrawing an application to try to qualify for the later one.

In the most recently published cycle, for posts starting August 2026, applications opened on 23 October 2025 and closed on 20 November 2025. The first MSRA window ran from 6 to 19 January 2026 and the second from 12 to 25 February 2026, with results released from 17 March 2026. The equivalent timeline for the next round is normally published in the autumn, so check the official recruitment timeline rather than assuming these dates repeat exactly.

Appointments can be rescheduled or cancelled through your Pearson VUE account up to 24 hours beforehand. Candidates with a disability covered by the Equality Act 2010 can apply for extra time of 25% or 50%. Travel and accommodation are your own cost: "expenses incurred by applicants in sitting the MSRA will not be reimbursed by the MSRA team".

Preparation

How to prepare for the MSRA

CPS rewards breadth rather than depth. Twelve clinical areas at foundation level is a lot of ground, and the paper will happily ask you about a dermatological presentation you last thought about in third year. Wide, shallow revision beats deep specialism. The other half of the problem is the clock: fifty-two seconds a question means that recognising a presentation quickly matters as much as knowing it, which is a skill you only build under timed conditions.

Professional Dilemmas gets written off as impossible to revise for. That is a mistake. The paper is marked against a fixed key built around a consistent set of principles: patient safety first, escalate appropriately, address problems directly rather than going around people, never cover for a colleague at a patient's expense. Reading the GMC's Good Medical Practice properly, and practising enough scenarios to internalise how the key thinks, reliably moves scores. The ranking format itself also costs marks until you have done a few dozen of them.

Whatever you revise from, do a meaningful share of it under exam timing. Almost everyone who underperforms on the MSRA knew more medicine than their score suggested; they simply ran out of time.

Common questions

MSRA frequently asked questions

Go to the source

Official MSRA guidance

Everything above is drawn from NHS England's own guidance. Recruitment rules change between rounds, so confirm anything decision-critical against the official pages before you rely on it.

• NHS England overview of the MSRA
• Structure of the MSRA
• The Professional Dilemmas paper
• The Clinical Problem Solving paper
• Booking the MSRA
• Rescheduling, cancellations and expenses
• Outcomes, scores and appeals
• How GP recruitment uses the MSRA
• Oriel, the UK specialty training application portal

Facts on this page were last checked against official NHS England guidance in August 2026.