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How to get through the MSRA: my experience - Part 1

Updated: Mar 29, 2023

By Aalia Pagarkar

Hello everyone! My name is Aalia, I am an FY4 doctor working as a Medical Education Fellow this year. I decided to apply for General Practice and part of this application process requires us to complete an exam called the Multispecialty Recruitment Assessment (or MSRA for short). I thought I would write a bit about my experience of preparing for and sitting the exam, and summarise a few tips and learning points that I discovered as I went through the process.

Background information

Firstly, just a bit of background information… Usually applications for specialty training open in November, and after you apply for General Practice, you will be invited to book a sitting for the MSRA in the early part of January – this year the exam slots were between 5th January and 17th January 2023. The exam will be taken in Pearson Examination centres (similar to the places where you sat your driving theory exam) but under extremely special circumstances, they may allow you to sit the exam at home or elsewhere if you meet certain criteria – these will be looked at on a case by case basis. When you apply for GP training through Oriel, you will get an email shortly afterwards asking you to register with Pearson Vue online – this is so that you can apply for the MSRA exam.

Screenshot of the Oriel page

Screenshot of the Pearson Vue page

Usually the slots for exam times get released in early to mid December and they tend to go quite quickly for popular areas e.g. London. What is even more annoying is that despite Pearson Vue saying that they would email us when the exam slots are released, I discovered this year that this is unfortunately not always the case. I started refreshing the Pearson Vue page one day prior to the exam slots officially being released, and this is when I discovered that the exam slots were already open to book. I would recommend not waiting for the email, but rather just keeping an eye out and refreshing the Pearson Vue application page several times one or two days prior to the official date that they say they will be releasing the slots. My official email from Pearson saying that the slots had been released only came 2 days later! If you wait for the email, you may have to go to an examination centre that is a very long way away from you as the popular sites may have already run out of slots. Having said that, some sites do release extra slots a day or two later in case you find that you don’t have the slot that you want or a place that you don’t want.

The MSRA is not just for GP applicants, but is also required for other specialties including:

- Clinical Radiology

- Psychiatry

- Ophthalmology

- Obstetrics and Gynaecology

- Community Sexual and Reproductive Health

- Neurosurgery

- Nuclear Medicine

- ACCS Emergency Medicine

- Anaesthetics

- Core Surgical Training

The MSRA scores are used in different ways in each of the above specialties, so please check the individual specialty’s national recruitment office website to find out more about how these scores are used. For General Practice, your performance in the MSRA is the ONLY thing that will be looked at in terms of ranking – therefore it is important that you find out as much as possible about the exam structure and prepare in advance for it. Please remember that if you do not register with Pearson Vue and / or do not take the MSRA exam, you application for GP will be withdrawn.

A bit about the exam structure

The MSRA has two parts to it – a Clinical Problem Solving Exam and a Professional Dilemmas exam. Both of these parts will be given in the same sitting – so usually you would first sit the Professional Dilemmas, and then the Clinical Problem Solving paper after an optional 5 minute break. There are 50 Professional Dilemma questions, 42 of which will contribute to the overall final score and 8 of which are pilot questions. You will have 95 minutes to complete these. There are 97 Clinical Problem Solving questions, 86 of which will contribute to the final score, and 11 of which are pilot questions, for which you will have 75 minutes to complete.

The Professional Dilemmas questions are quite like the SJT exam we take at the end of medical school. It is composed of ranking questions where you would have to rank the options in order of appropriateness (NOT the order in which you would do the actions – this is different) and multiple choice questions in which you have to select three options that together will comprise of the best way forwards and this combination should fully resolve the problem. These questions are about common scenarios you may encounter as a junior doctor, and tests your professional behaviour when coming across certain scenarios. This exam covers 3 core competencies:

1. Professional Integrity e.g. being honest, admitting mistakes, knowing your own boundaries, taking responsibility, striving to do what is in the best interests of the patient, proactive approach to work.

2. Coping with pressure e.g. willing to admit when feeling overwhelmed and seeking assistance, remaining calm under pressure, recognising your own limitations, managing criticism well, able to balance various responsibilities and commitments, responding flexibly when required.

3. Empathy and sensitivity e.g. taking a holistic approach to patient care, empowering patients, acknowledging a patient’s needs and worries, acting in an open and non-judgemental manner, has a caring approach to both patients and colleagues.

There is no negative marking, so I would recommend answering all questions as best as possible. The Professional Dilemmas problems wont necessarily require you to know any clinical knowledge, but will require you to have a general knowledge of primary and secondary healthcare.

The Clinical Problem Solving Exam looks at your clinical reasoning and knowledge. All of this knowledge is based on Foundation level clinical practice, and will test your ability to apply the knowledge, not just remember random facts. The Clinical problem solving paper is based on 12 clinical areas including:

1. Cardiovascular system

2. Dermatology / ENT / Ophthalmology

3. Endocrinology / Metabolic

4. Gastroenterology / Nutrition

5. Infectious Diseases / Haematology / Immunology / Allergy / Genetics

6. Musculoskeletal

7. Paediatrics

8. Pharmacology and therapeutics

9. Psychiatry / Neurology

10. Renal / Urology

11. Reproductive system

12. Respiratory

The paper will cover 5 competencies across all of these specialties including:

1. Investigation

2. Diagnosis

3. Emergency

4. Prescribing

5. Management

About half of the Clinical Problem solving paper is comprised of Single Best Answer questions in which you will have to select the most appropriate answers given for a clinical presentation. The other half will be Extended Matching questions in which you will have about 8-10 possible responses, and then given 3-5 questions linked to this response set. Each response in the Extended Matching Questions can be used once, more than once, or not at all.

Are you finding this blog post super informative?

Stay tuned for Part 2, where I discuss preparation for the papers, my exam experience and top tips too!!

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