The Multi-Specialty Recruitment Assessment (MSRA) is the gateway to GP specialty training and several other UK postgraduate training programmes. Your MSRA score now determines, on its own, whether you get a GP training offer and which deanery you end up in — making it one of the highest-stakes computer-based exams a UK doctor will sit.

This page is the Core Revision MSRA hub: what the exam is, who sits it, how it’s scored, the dates for 2026 and 2027, the scores you need for the specialty you’re aiming at, and free sample questions across the Clinical Problem Solving and Professional Dilemmas papers. Our dedicated MSRA question bank is coming soon — join the waitlist below to be told the day it goes live, and to get our free MSRA stats & admin cheat sheet in the meantime.

What is the MSRA?

The MSRA is a 195-minute computer-based assessment delivered by Pearson VUE at test centres across the UK and overseas. It has two papers sat back-to-back:

• Professional Dilemmas (PD) paper — 50 situational judgement items in 95 minutes, mixing ranking questions and multiple best answer questions. Tests integrity, empathy, coping with pressure, and decision-making under uncertainty.
• Clinical Problem Solving (CPS) paper — 86 items in 75 minutes, single best answer and extended matching questions across the core medical syllabus you covered at medical school plus common general-practice scenarios.

Each paper is scored independently. Most specialties combine the two scores; some weight them differently. For GP, the combined score is the single ranking criterion.

Who sits the MSRA?

The MSRA is required for entry into:

• General Practice Specialty Training (the largest cohort — over 8,000 applicants annually)
• Psychiatry CT1
• Radiology ST1
• Ophthalmology ST1
• Neurosurgery ST1
• Anaesthetics CT1
• Public Health ST1
• Occupational Medicine ST3

The exam is the same for every applicant; the score is then used differently by each specialty. For GP applicants in 2026, the MSRA score is now the sole selection criterion — there is no longer a separate interview stage.

MSRA 2026 and 2027 dates

The MSRA runs in two sittings per recruitment round — for 2026 entry, one in January (all specialties) and one in February (GP and Core Psychiatry only). Exact dates and booking windows are published by NHS England Workforce, Training and Education. Check the official MSRA page for confirmed dates before you book.

What score do you need?

Cut-off scores shift each year with the applicant pool but as a rough guide:

• GP training: a combined score around 470–500 typically secures a London or South-East offer; 420–450 secures most other deaneries; below 380 risks being unranked.
• Radiology / Ophthalmology / Neurosurgery: 540+ to be competitive at interview stage.
• Psychiatry / Anaesthetics: 470+ to be safely shortlisted.

These are heuristics, not guarantees. Your competition each year is the cohort that sat the same paper as you, and the cut-offs are set on a percentile basis after marking. (Last reviewed May 2026 — verify the current cycle’s competition ratios before relying on these bands.)

How to prepare for the MSRA

The MSRA rewards three things: clinical breadth, calm under time pressure, and a robust ethical framework. The trainees who score in the top decile do all of these:

• Start the PD paper early. The situational judgement section can’t be crammed — the “right” answers are a reflection of how the GMC and NHS England expect you to think, and that takes time to internalise. Start at least 8 weeks out.
• Drill CPS by topic, not chronologically. Don’t go A-to-Z. Hit the high-yield areas first — cardiology, respiratory, GI, mental health, women’s health, paediatrics — and revisit your weakest topic every other day.
• Time yourself from week one. The CPS paper averages 52 seconds per question. Most candidates fail not on knowledge but on pace.
• Mock under exam conditions. Four full mocks in the last fortnight, all timed, all single sitting. The fatigue management is half the battle.

Free MSRA sample questions

Six worked sample questions — three Clinical Problem Solving and three Professional Dilemmas — to give you a feel for the format and the Core Revision house style.

Sample CPS 1 — respiratory

A 64-year-old man with a 40 pack-year smoking history attends with three months of progressive breathlessness on exertion and an unproductive cough. Spirometry shows an FEV1/FVC ratio of 0.62 with FEV1 56% predicted, no reversibility. CXR is unremarkable. What is the most appropriate first-line inhaler therapy under NICE NG115?

Answer: A short-acting bronchodilator (SABA or SAMA) as needed. NG115 recommends short-acting bronchodilators for all symptomatic COPD patients first-line; LAMA/LABA combinations are reserved for those still breathless with persistent symptoms despite SABA/SAMA and without asthmatic features.

Sample CPS 2 — statistics

A new screening test for condition X has a sensitivity of 90% and a specificity of 95%. The condition has a prevalence of 1% in the population being screened. A patient tests positive. What is the approximate positive predictive value (PPV)?

Answer: Roughly 15%. Out of 10,000 screened, 100 have the disease and 9,900 don’t. True positives = 90 (90% × 100). False positives = 495 (5% × 9,900). PPV = 90 / (90 + 495) ≈ 15%. Even a highly sensitive and specific test produces lots of false positives at low prevalence — the classic AKT/MSRA stats trap.

Sample CPS 3 — safeguarding

A 7-year-old child attends with her mother after a fall. The bruise pattern on the inner thigh is unusual and inconsistent with the mother’s account. The child is quiet and avoids eye contact with the mother. The most appropriate immediate action is to:

Answer: Make an urgent referral to the local safeguarding lead and / or local authority children’s social care. Do not delay to gather more information. Do not confront the parent. The threshold for referral is “reasonable concern”, not proof, and the GMC’s 0-18 guidance is explicit that protecting the child outweighs concerns about damaging the parent-doctor relationship.

Sample PD 1 — ranking

You are an FY2 in A&E. A patient with chest pain is moved to majors. Your registrar tells you to clerk them now. As you walk over, a colleague pulls you aside to say she made a prescribing error two days ago that has not yet been recognised. Rank the following actions from most appropriate (1) to least appropriate (5):

• A. Clerk the chest pain patient immediately as instructed, then return to your colleague.
• B. Ask the colleague to wait, escalate the chest pain patient, then sit down with her properly.
• C. Stop and discuss the error with your colleague before clerking the chest pain patient.
• D. Tell your colleague to report the error herself via Datix and continue with the patient.
• E. Tell your registrar about the colleague’s error and let her handle it.

Suggested ranking: B, A, D, C, E. The clinical urgency comes first, but the colleague’s error needs proper attention — not deferral and not gossip up the chain without her involvement. The key is acknowledging both and sequencing them appropriately.

Sample PD 2 — multiple best answer

A patient with diabetes asks for a fit note backdated by two weeks so they don’t lose pay for time they took off. Their notes show they did call in sick during that period and have a documented history of poorly controlled diabetes. Which THREE of the following are appropriate responses?

• A. Decline to backdate any fit note.
• B. Explain that you can issue a fit note from today, and you can refer to the previous absence in the comments.
• C. Backdate the fit note to keep the patient onside.
• D. Document the conversation and your reasoning clearly.
• E. Offer to write a separate supporting letter for the employer.
• F. Refer to your defence body for advice if uncertain.

Best answers: B, D, E. You cannot ethically backdate a fit note for time you did not assess, but you can acknowledge the prior absence in writing, and a supporting letter from the GP is reasonable. Document the decision either way.

Sample PD 3 — ranking

You are on call overnight. A consultant phones to ask you to prescribe a medication that you have never prescribed before, by phone, without seeing the patient. You know there is a nurse practitioner on the ward who could clarify. Rank the following actions from most appropriate (1) to least appropriate (5):

• A. Ask the consultant to explain the indication and reasoning so you can prescribe safely.
• B. Refuse to prescribe and end the call.
• C. Prescribe as asked — the consultant is responsible.
• D. Ask the nurse practitioner to review the patient with you and call back.
• E. Defer the decision to the morning team.

Suggested ranking: A, D, E, C, B. You should not prescribe blind, but you also should not refuse outright in a way that delays care. Asking for context and involving the nurse practitioner who has eyes on the patient is the highest-rated path.

Be told the day the MSRA question bank launches

Our full MSRA question bank is in active development — 2,000+ Clinical Problem Solving items and 250+ Professional Dilemmas, all written by UK GPs and ST3s, all NICE-linked or GMP-linked. Drop your email and we’ll tell you the day it goes live. We’ll also send you our free MSRA stats & admin cheat sheet in the meantime.

Related guides on Core Revision

• The Ultimate AKT Statistics Guide — the same stats appear in MSRA Clinical Problem Solving.
• Free AKT Stats Cheat Sheet — print-and-pin for the fortnight before your sitting.
• GP Admin Desk — sick notes, capacity, prescribing law, DVLA — useful for the Professional Dilemmas paper.
• Core Revision homepage — AKT preparation for once you’re through training.