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The Multi-Specialty Recruitment Assessment (MSRA) and Core Surgical Training (CST) Applications

In recent weeks, the Joint Committee on Surgical Training (JCST) confirmed the introduction of the Multi-Specialty Recruitment Assessment (MSRA) as part of the selection process for Core Surgical Training (CST) from 2023. Previously, the portfolio self-assessment score would be used to shortlist applicants for CST interviews.

From 2022-2023:

- MSRA exam score will be used as a score cut-off for CST interview shortlisting

- MSRA exam score will account for 10% of final CST selection score

The MSRA exam consists of two different papers: the Professional Dilemmas paper and the Clinical Problem Solving paper.

Professional Dilemmas Paper

The Professional Dilemmas paper is a situational judgement test that aims to measure how candidates behave in the face of a challenging dilemma. The paper consists of 50 questions in 95 minutes, and scenarios are set within the context of an F2 doctor.

Half of the questions will ask candidates to rank 5 options in order (1-5) of appropriateness; the other half are multiple choice questions, where you are asked to choose the most appropriate 3 choices from 8 options.

The top score for each ranking question is 20, but even if you put them all in the wrong order completely, you are still allocated 8 marks – so aim to answer all questions. Remember, the main aims are to be a supportive colleague and a good doctor who makes safe decisions!

8 of the 50 questions are “pilot” questions that do not count towards the candidates final score.

Rather than assessing problem-solving ability, this paper focusses on assessing professional attributes. The three core competencies covered are:

- Professional Integrity

- Coping with Pressure

- Empathy and Sensitivity

An example ranking and multiple choice question from the Professional Dilemmas paper:

The Answers:

Clinical Problem Solving Paper

The Clinical Problem Solving paper includes domains that focus around either investigations, diagnosis, emergencies, prescribing or management. Candidates will have 75 minutes to answer 97 questions, with half being Extended Matching Questions (EMQs) and the other half being Single Best Answers (SBAs).

11 of the 97 questions are “pilot” questions that do not count towards the candidates final score.

The 12 different clinical topics covered are:

  • Cardiovascular

  • Dermatology/ENT/Ophthalmology

  • Endocrinology/Metabolic

  • Gastroenterology/Nutrition

  • Infectious diseases/Haematology/Immunology/Genetics

  • Musculoskeletal

  • Paediatrics

  • Pharmacology & Therapeutics

  • Psychiatry/Neurology

  • Renal/Urology

  • Reproductive

  • Respiratory

An example SBA and EMQ question from the Clinical Problem Solving paper:


Candidates will receive results soon after the assessment is completed. Scores for each paper are normalised around a mean score of 250 ± 40. The scores for each paper are also banded 1 to 4, with 1 being failure to achieve the minimum acceptable standard.

Our Tips

  • With CST applications opening soon, there is a short amount of time left. Try to allocate as much time as you can preparing for the MRSA. Look to put regular time in after (or before) work each day and build up the time closer to the exam.

  • We are big believers of practicing questions as a good way to revise. It will teach you what you need to know (content wise) and also give you those much needed pattern recognition skills.

  • Try to time yourself early into your practice to get used to exam conditions.

  • Read through the GMC Good Medical Practice guide before the exam to remember key ethical principles for the Professional Dilemmas paper.

  • Familiarise yourself with the 2-week wait criteria - these question themes are common.

  • Remember the exam is aimed at experience of an FY2 doctor, so if you are taking the exam you will have come across these situations in real-life, remain calm throughout and employ the exam technique that has worked best for you during your medical training!

Revision Materials

  • Pass Medicine

  • Pastest

  • E-Medica

  • MCQBank

  • Medibuddy

  • Oxford handbook for General Practice

Thank you for taking the time to read, we hope that you found it useful any questions feel free to reach out to our team and we will try our best to get you the answers. YOU GOT THIS!

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