Core Revision
Is the MSRA hard?
Dr Laura YoungSpecialist Adviser, Educational Design & Neuro-inclusion · 3 min read
Written August 2026
The knowledge is Foundation level. Almost none of it is beyond what you already use. What makes the MSRA hard is 86 clinical items in 75 minutes — about 52 seconds each — and a second paper that most people have no idea how to revise for.
“Is it easy?” and “can I walk in unprepared?” are different questions. The first is arguably yes. The second is firmly no.
The Clinical Problem Solving paper gives you 75 minutes for 86 items. That is under a minute each, including the extended matching questions where you have to read a list of options first. For comparison, the AKT allows roughly a full minute per question and is widely considered time-pressured.
The pace, not the medicine
Nothing in the CPS paper is beyond an F2. The difficulty is that you have to recognise, decide and move on at a rate that leaves no room for deliberating. Doctors who know the material well but work carefully are the ones most likely to run out of time — and carefulness is a virtue everywhere except here.
Sitting the MSRA? See where you stand.
Try twenty original MSRA questions, ten Professional Dilemmas and ten Clinical Problem Solving, marked on the near-miss principle NHS England describes. Free, no card and the first five are open to all.
Half of it is not a knowledge test at all
The Professional Dilemmas paper measures judgement — professional integrity, coping with pressure, empathy and sensitivity — in the role of an F2. There is nothing to memorise, which people mistake for nothing to prepare. In fact the format is highly learnable: knowing how ranking items are scored, and recognising the shape of the options that score well, is worth real marks.
Both of those are trainable, and free to train: the Professional Dilemmas Reasoner shows exactly how ranking partial credit works and drills the two formats the paper uses. What counts as a good score explains what your number actually means once it comes back.
You are ranked, not passed
There is no pass mark to clear and relax about. Every extra mark moves you up a list against everybody else, so there is no natural point at which you have “done enough”. That is psychologically quite different from an exam with a threshold, and it is why the MSRA generates more anxiety than its difficulty warrants.
There is no negative marking in either paper, so a guess always beats a blank. And the assessment is deliberately built to be fair across graduation routes — scenarios are reviewed to strip out locality-specific policy knowledge, and every item goes through an English-not-first-language review.
People describe the MSRA as hard when what they mean is fast. Those need completely different preparation, and only one of them is fixed by knowing more medicine.
— Dr Laura Young, Specialist Adviser, Educational Design & Neuro-inclusion
The honest summary: the MSRA is not conceptually difficult and it is not designed to catch you out. It is a speed and judgement assessment wearing the clothes of a clinical exam. Prepare for the clock and for the Professional Dilemmas format, and it becomes a considerably smaller thing than its reputation.
