Core Revision
MSRA for neurosurgery, CSRH and nuclear medicine: the smaller specialties
Beyond the big Round 1 fields, three smaller specialties also select with the MSRA — including the single most competitive ratio in UK recruitment and one of the very few published numeric cut-offs. If you are applying to neurosurgery, community sexual & reproductive health (CSRH) or nuclear medicine, here is how the exam is used. Checked against NHS England’s specialty recruitment pages on 29 August 2026.
Neurosurgery ST1
| Uses the MSRA? | Yes — every applicant sits it in the round they apply in |
| Role | Feeds shortlisting for interview; there is no interview bypass — the interview decides the final order |
| Competition (2025) | 561 applications for 21 posts — 26.7 per place, among the most competitive entry pathways in the country |
| Programme | 8-year run-through |
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.
With over 26 applicants per post, the shortlisting stage does most of the eliminating. Applicants describe a four-station interview covering clinical scenarios, management, motivation and referrals (the official handbook is not publicly accessible, so treat that as unofficial) — but you have to score your way into the room first.
Community Sexual & Reproductive Health ST1
| Uses the MSRA? | Yes — mandatory for all applicants |
| Role | Decides who reaches the interview; no bypass, no published cut-off |
| Competition (2025) | 1,379 applications for 14 posts — 98.5 per place, one of the highest ratios of any UK specialty |
| Programme | 6-year run-through, UK-wide recruitment via Oriel |
CSRH is tiny and has seen explosive applicant growth — from 272 applications to 1,379 in two years. At nearly 99 applicants per post, the effective MSRA bar to reach interview is necessarily high, even though no score is published. If CSRH is your goal, treat the MSRA as the whole campaign.
Nuclear Medicine ST3
| Uses the MSRA? | Yes — one of the very few ST3-level specialties that does; a fresh sitting is required (“we will not accept MSRA scores from any previous sittings”) |
| Role | Shortlisting, with a published cut-off: 201 on each of the two papers (2026 entry); applicants then ranked by MSRA for interview allocation |
| Interview | Two stations of up to 15 minutes, with portfolio review built into the first |
| Scale | A very small intake — two England posts were filled in 2025 |
One quirk worth knowing: if you are also applying to Clinical Radiology ST1, that is a separate Oriel application — the two are not bundled despite the shared college connection.
The exam itself — same for all three
One computer-based sitting, 170 minutes, two papers, identical for every specialty that uses it:
| Paper | Time | Format |
|---|---|---|
| Professional Dilemmas (sat first) | 95 min | 50 situational judgement questions — ranking and multiple-choice |
| Clinical Problem Solving | 75 min | 86 questions across the breadth of general clinical practice |
None of these specialties appears meaningfully in the exam content — it is a generalist assessment at foundation level. All three sit the January window (in the 2026 cycle, 6–19 January; February was reserved for GP and Core Psychiatry applicants).
Dates for 2027 entry
The national dates are published — Round 1 applications 22 October to 19 November 2026 and the MSRA window 5–20 January 2027 (invitations 14 December 2026) — but none of the three specialty pages has its 2027 detail yet. Our MSRA 2027 dates tracker is updated the day NHS England publishes. Note also that the Medical Training (Prioritisation) Act — in force since March 2026 — will apply at both the shortlisting and offer stages for 2027, so recent competition ratios are an imperfect guide to what you will actually face.
How to prepare
- 500 original Professional Dilemmas scenarios across the three competencies the PD paper tests
- 1,700+ Clinical Problem Solving questions across the CPS topic areas (a core written for the MSRA, the rest Foundation-level clinical questions shared with our AKT bank)
- Full timed mocks of both papers, built to the real timings
- Guideline-linked explanations on every question
Explore the MSRA question bank · Plans & pricing
Prefer to start free? Our open Ethics, Law & Safeguarding guide covers the professional-practice ground the PD paper leans on — no account needed.
Frequently asked questions
Do these smaller specialties sit a different MSRA?
No — there is one MSRA. Every specialty that uses it sees the same papers, the same timings and the same marking; only what each specialty does with the score differs.
Is 201 per paper the pass mark?
Only nuclear medicine (and radiology) publish 201-per-paper as a minimum to stay in the process, and clearing it merely keeps you in — interview allocation still runs on MSRA rank. Neurosurgery and CSRH publish no threshold at all.
Can I apply to several of these with one MSRA sitting?
Yes — one sitting serves every MSRA specialty you apply to in that round (in the 2026 cycle, Round 1 allowed up to five applications). Each specialty still needs its own Oriel application.
Related
- The MSRA question bank
- MSRA 2027: dates, format and what is confirmed
- January vs February sitting: who sits when
- MSRA for Radiology
- MSRA for O&G
Checked 29 August 2026 against NHS England’s specialty recruitment pages (neurosurgery and CSRH interview mechanics rest partly on widely-used preparation resources where official recruiter pages are not publicly accessible) and 2025 competition-ratio data. Selection processes change between cycles — always verify against the current applicant guidance for your cycle before relying on any figure here.
