The Ultimate MSRA Guide (Revision, Scoring & Tips)

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:

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.

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 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 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.

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:

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.

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.

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.