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Demystifying the Multi-Specialty Recruitment Assessment (MSRA): A guide for IMGs

The Multiple Specialty Recruitment Assessment (MSRA) is a crucial test that all doctors have to take when applying for UK residency in certain specialties. In this guide, we will explore the purpose of the MSRA, its impact on different specialty programs, and effective preparation strategies.

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Published June 13, 2023

The Multiple Specialty Recruitment Assessment (MSRA) is a crucial test that all doctors have to take when applying for UK residency in certain specialties. I took it when I applied for Ophthalmology training, and you are likely to need this exam if you plan to apply for some of the other more competitive specialties.

In this guide, we will explore the purpose of the MSRA, its impact on different specialty programs, and effective preparation strategies.

What is the purpose and impact of the Multiple Specialty Recruitment Assessment (MSRA) on UK residency applications?

The MSRA is a computer-based exam that plays an important role in your application to specialty training (residency) in the UK.

For some specialties, it serves as the basis for shortlisting candidates for limited interview slots, and in most specialties, it often contributes to the final score that determines who gets selected for specialty training.

Each specialty programme has its own unique approach to evaluating MSRA scores (see table below).

Contribution of the MSRA to various Specialty Programmes

Specialty Training ProgramContribution of MSRA score for an invitation to interviewContribution of MSRA score to the allocation of offers
ACCS Emergency Medicine100%MSRA (40%) + Interview score (60%)
Anaesthetics100%MSRA (15%) + Interview score (85%)
Clinical Radiology100% (All applicants that score higher than the cut-off score but are not initially invited to interview will be put on a reserve list.)MSRA + Verified self-assessment score + Interview score
Community Sexual and Reproductive Medicine100%Ranked on interview score
Core Surgical Training100%MSRA (10%) + Verified evidence score (30%) + Overall interview score (60%)
Core Psychiatry TrainingN/A100%
General PracticeN/A100%
NeurosurgeryRaw shortlisting score and MSRA are scaled to produce a combined shortlisting score. Combined shortlisting/MSRA score will be used to rank applicants and fill interview capacity.Applicants will be ranked and appointed based upon their combined shortlisting/MSRA and weighted interview score
Nuclear Medicine (ST3)100% (All applicants that score higher than the cut-off score but are not initially invited to interview will be put on a reserve list.)MSRA + Verified self-assessment score + Interview score
Obstetrics and GynaecologyIf you meet the bypass score (TBC) then you will not need to attend for interview. Those remaining will be ranked and invited to interview based on capacity.  If your MSRA score is too low, you will not be shortlisted.Scaled MSRA score (33.3%) + Overall interview score (66.7%)
OphthalmologyMSRA results will be used to reduce the number of applicants for interview.MSRA score + Portfolio of evidence + Online Assessment

Table 1 – Contribution of MSRA to the application process of various Specialty Training Programs (Source: Mind The Bleep https://mindthebleep.com/msra/ Accessed 13 May 2023)

How can I book the MSRA?

The MSRA is not like PLAB or any other exam, in that you cannot book it at any time. The only time you’ll be able to book the MSRA is when you submit an application for UK specialty training (residency) in a specialty that requires the MSRA.

Fortunately, it is also not like PLAB in that there are no fees to sit the MSRA, it’s computer based, and it can be taken in most countries worldwide.

What is the structure and approach of the MSRA exam?

Understanding the structure and approach of the MSRA is crucial for effective exam preparation. The MSRA is a computer-based exam consisting of two papers:
Professional Dilemmas PaperClinical Problem Solving Paper
What it assessesNon-technical skills as a doctorClinical knowledge in these specialties:
Cardiovascular
Dermatology / ENT / Eyes
Endocrinology / Metabolic
Gastroenterology / Nutrition
Infectious disease / Haematology / Immunology / Allergies / Genetics
Musculoskeletal
Paediatrics
Pharmacology and therapeutics
Psychiatry / Neurology
Renal / Urology
Reproductive
Respiratory
Domains being testedProfessional Integrity
Coping with Pressure
Empathy and Sensitivity
Investigations
Diagnosis
Emergencies
Prescribing
Clinical Management
Number of questions5097
Type of questionsRanking
Multiple-choice
Extended matching questions
Single best answer
Time allotted95 minutes75 minutes
Table 2 – Comparison of the 2 papers of the MSRA The exam duration is 170 minutes in total with a 5-minute break between the 2 papers.

How can I effectively prepare for the MSRA as an IMG?

To achieve success in the MSRA, a well-structured timeline and effective study strategy are essential. I personally only prepared for the MSRA for 1 month, but with the increasing levels of competition, 1 month is no longer sufficient. If I were preparing for it again today, I would definitely allocate more time.

Ideally you should start your revision 2-3 months before the exam. Start by reviewing your work schedule and identifying the times that you can dedicate to study. When deciding how much time to dedicate study each week, consider what percentage of your overall score will come from the MSRA

For example, GP and Psychiatry both rely 100% on the MSRA score so you’ll want to spend more time preparing for it. Likewise, some specialties like Core Surgery, use the MSRA score alone to decide who goes through to interview, and even whether or not to score your portfolio. This means that if you don’t do well on the MSRA, all your hard work on the portfolio will not be able to save you.

Also be sure to balance the focus of your revision. Start with some questions from a question bank to reveal your weak areas, then tailor your study plan to read up on those areas and try new questions.

As the exam approaches, aim to have a few days free for focused study and mental preparation. When booking the exam, secure a date and centre that suits your schedule to avoid unnecessary travel stress. Remember to prioritise rest and avoid cramming the night before the exam.

Related article: An IMG’s guide to the UK portfolio for training jobs

How can I excel in the Professional Dilemmas Paper of the MSRA as an IMG?

The Professional Dilemmas Paper of the MSRA is designed to assess ethical decision-making abilities. It focuses on three core competencies: Professional Integrity, Coping with Pressure, and Empathy and Sensitivity.

As an IMG, the first thing you should do is familiarise yourself with the GMC ethics. GMC Good Medical Practice lays out the “code of conduct and behaviour” expected of UK doctors and should guide your answers. Also check out their Good medical practice in action to see how you can apply the principles to real situations.

Like any other exam, you should also do some practice questions to help you get into the correct mindset. There are limited resources out there but we recommend trying the official SJT questions for FY1, as well as Arora Medical Education’s MSRA preparation course. (Use the code ARORASAVVY10 to get 10% at checkout, even if there’s an ongoing sale)

Other test principles to keep in mind are the following:

  • Examine the wording in each question carefully. Look for any words or phrases that represent black and white thinking or an aggressive approach.
    • For example, beware of choices that include absolute terms like “always” or “never” or words like “argue” or “confront.”
  • Answers that involve finding out more details and exploring the problem further, tend to rank higher than answers that make an immediate judgement and take definitive action.
  • Answers that encourage learning from mistakes also tend to rank higher.
  • Avoid making any assumptions of details outside of the question. Only use the information provided in the question. If something important is missing, it’s for a reason – hence why answers where you explore the problem further rank higher.
  • Patient safety is always the top priority. For each question, ask yourself if your response puts the patient’s safety first. Prioritising your own well-being is also important, but only if there is no immediate threat to a patient’s safety.

Mastering the Professional Dilemmas Paper requires a thoughtful approach, ethical reasoning, and a patient-centric mindset.

How can I conquer the Clinical Problem Solving Paper of the MSRA?

The Clinical Problem Solving Paper is a significant component of the MSRA, assessing your clinical knowledge across different specialties.

The paper covers 12 specialties:

  • Cardiovascular
  • Dermatology / ENT / Eyes
  • Endocrinology / Metabolic
  • Gastroenterology / Nutrition
  • Infectious disease / Haematology / Immunology / Allergies / Genetics
  • Musculoskeletal
  • Paediatrics
  • Pharmacology and therapeutics
  • Psychiatry / Neurology
  • Renal / Urology
  • Reproductive
  • Respiratory

The questions within the Clinical Problem Solving Paper evaluate your ability to perform specific investigations, make accurate diagnoses, respond to potential emergencies, provide appropriate prescriptions, and offer management plans.

Approximately 50% of the questions will be in the form of extended matching questions, while the remaining 50% will be single best-answer questions.

As you juggle a full-time clinical job alongside MSRA preparation, you’ll need to keep your study sessions very focused and high-yield. Don’t attempt to read full textbooks! Utilise question banks to practice your ability to apply clinical knowledge in the different question formats, while also pinpointing the exact areas you need to refresh your knowledge on.

When revising, prioritise breadth over depth, as the exam aims to assess your overall understanding of clinical scenarios rather than specialist knowledge.

Related article: What you need to know about PLAB 1

How else can I maximise my exam readiness for the MSRA?

On top of allocated dedicated time for study, and using question banks in your revision plans, here are some other tips to get ready for the big day:

  1. Time Management: Don’t just go through questions for hours on tend. Practice time management during your exam preparation by simulating the actual exam conditions.

    Set realistic time limits for each section and learn to prioritise questions effectively to ensure you make the most of the allocated time. If you encounter a challenging question, don’t get stuck for too long. Flag it and move on, returning to it later if time permits.

    Don’t skip any questions, even if you’re not sure, try to answer all questions since there is no negative marking.

  2. Mock Exams: Take advantage of mock exams to simulate the exam environment and assess your performance. This will help you identify areas of improvement and fine-tune your exam strategies.
  3. Rest and Relaxation: Prioritise self-care and ensure you get enough rest the night before the exam. Avoid cramming or engaging in last-minute intensive studying, as it can negatively impact your performance. A well-rested mind is vital for optimal exam performance.
  4. Exam-Day Preparation: Familiarise yourself with the exam logistics and arrive at the test centre well ahead of time. Bring a valid ID, follow all instructions provided, and stay calm and focused during the exam.

Remember, success in the MSRA is a culmination of thorough preparation, strategic approach, and confidence in your abilities.

Related article: 8 tips to succeed when applying for UK specialty training

Resources for the MSRA

To further enhance your MSRA preparation, there are several additional resources and references available that can provide valuable insights and guidance. Here are some recommended resources to complement your study:

  1. Ethical Guidance Documents: Read through the GMC “Good Medical Practice,” and “Good Medical Practice in Action” to enhance your understanding of professional dilemmas and ethical considerations.
  2. Foundation School SJT Past Papers: You can try past papers for the FY1 Situational Judgement Test (SJT) available on the Foundation School website. Although not specific to the MSRA, these papers can provide valuable practice for the Professional Dilemmas Paper.
  3. Question Banks: Utilise reputable question banks that focus on MSRA-style questions. These banks can help you familiarise yourself with the question formats, assess your knowledge, and identify areas that require additional attention.
  4. Our recommendation: Arora Medical Education MSRA Resources. Explore Dr Aman Arora’s preparation material, and get 10% off using the code SAVVY10 when purchasing their helpful materials and tools designed to support your MSRA preparation.

Good luck on your MSRA journey and showcasing your commitment to excellence as a healthcare professional!

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Meet the Team

Hi, we’re Drs Nick & Kimberly Tan, the two IMGs behind The Savvy IMG. We write comprehensive guides, create courses, and provide one-to-one guidance to help other overseas qualified doctors on their journey to the UK.
We have scoured the official guidance to put these posts together, but we can make mistakes! If you spot anything that is incorrect, please get in touch and we’ll put it right.
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