Multispecialty Recruiting Assessment
Dr Vinson Chan
National exam set at an FY2
What is the MSRA? level for specialty applications,
originally intended for GPs
GP, Radiology, O&G, A&E,
Anesthetics, Psychiatry, Core
Surgical Training, Nuclear
Medicine
How is the MSRA scored
Not entirely transparent
Two parts median score
• Clinical Problem Solving: 250 (SD 40)
• Professional Dilemmas: 250 (SD 40)
• Average total score: 500
• Theoretical maximum score ??580 but a lot of people score
more than that
How is MSRA used in the radiology application?
2024
Before interview During interview
• Shortlisting: Cut off of >555 which is a really high score • 20% MSRA, 30% Portfolio, 50% Interview
BAD MSRA SCORE MEANS NO INTERVIEW
Competition Ratio
Before After
interview interview
11:1 2:1
Format of the
assessment
• Part One: Professional Dilemmas
• 95 minutes
• 50 Questions
• Part Two: Clinical Problem Solving
• 75 minutes
• 86 items
• Extended Matching Questions
• Single Best Answer
Professional Dilemmas
Professional Integrity
Coping with pressure
Empathy and Sensitivity
Example
You are a Foundation (F2) doctor working in a hospital. Mr Ahmed, a 62 year old man, is awaiting the results
of tests for bowel cancer. The ward clerk tells you that seven of his relatives are at his bedside. His eldest son
has specifically asked that you do not disclose the diagnosis to Mr Ahmed if it is cancer, as he feels his father
could not cope. Your consultant calls from the endoscopy suite and advises you that the diagnosis is a
sigmoid carcinoma.
Rank in order the following actions in response to this situation (1= Most appropriate; 4= Least appropriate).
Option A: Tell the ward clerk that you Option C: Ask all the relatives to clear
Option B: Tell the ward clerk to advise Option D: Ask Mr Ahmed whether he
will see the son in a side room prior the bedside as you need to discuss
the son that you have to respect Mr would like his son present when
to speaking to Mr Ahmed, to discuss the findings of the colonoscopy with
Ahmed's autonomy. discussing his results.
the reason for this request. Mr Ahmed privately.
Example 2
You are a Foundation (F2) doctor, at lunch with your F2 colleague, Sarah, who works on another
ward in the hospital. During lunch she is bleeped* for the fourth time by the nurses on her ward.
When she calls back you hear her shout down the telephone at one of the nurses.
Rank in order the following actions in response to this situation (1= Most appropriate; 5= Least
appropriate).
Option C: Telephone the nurses Option D: Ask Sarah if she Option E: Ask one of the F2
Option A: Ask other F2 Option B: Discuss the incident
on Sarah's ward to find out why would like to talk about the doctors on Sarah's ward to
colleagues if Sarah's behaviour with Sarah's educational
they needed to bleep her 4 nurses' requests and why she discuss with her how she speaks
is out of character. supervisor*.
times during lunch. responded in the way she did. to the nurses on the team.
Clinical Problem Solving
Dermatology / Endocrinology /
12 major topics Like mini finals! Cardiovascular
ENT / Eyes Metabolic
Infectious disease /
Gastroenterology / Haematology / Pharmacology and
Musculoskeletal Paediatrics
Nutrition Immunology / therapeutics
Allergies / Genetics
Psychiatry /
Renal / Urology Reproductive Respiratory
Neurology
Usually very very vague. Short stem.
“spot diagnoses” and ”buzz words”
Styles of
questions Extended Matching Questions
Single best answer
Tired all the time
• A 55 year old woman who complains that people
say she looks tired. On examination she has
thinning hair, dry skin and facial puffiness.
• For each patient, which investigation could
confirm the most likely diagnosis?
• A: 24-hours urinary catecholamines
• B: 24-hour urinary free cortisol
• C: Fasting glucose
• D: Fluid deprivation test with response to
desmopressin
• E. Renal function tests
• F: Serum calcitonin
• G: Serum growth hormone suppression test
• H: Thyroid function tests
Tired all the time
• A 35 year old man presents with tiredness. He
explains that his ring is getting much tighter.
• For each patient, which investigation could
confirm the most likely diagnosis?
• A: 24-hours urinary catecholamines
• B: 24-hour urinary free cortisol
• C: Fasting glucose
• D: Fluid deprivation test with response to
desmopressin
• E. Renal function tests
• F: Serum calcitonin
• G: Serum growth hormone suppression test
• H: Thyroid function tests
Antibody tests
A 24 year old woman with a past medical history of recurrent
miscarriages and deep vein thrombosis.
For each patient, what is the most appropriate investigation?
E: Anti-
A: Anti- D: Anti- G: Anti-
B: Anti-gliadin C: Anti-Jo neutrophil F: Anti-nuclear H: Anti-Ro I. Parietal cell
centromere mitochondrial phospholipid
antibodies antibodies cytoplasmic antibodies antibodies antibodies
antibodies antibodies antibodies
antibodies
Antibody tests
A 45 year old woman with fatigue, itch and jaundice.
Investigations reveal abnormal LFTs.
For each patient, what is the most appropriate investigation?
E: Anti-
A: Anti- D: Anti- G: Anti-
B: Anti-gliadin C: Anti-Jo neutrophil F: Anti-nuclear H: Anti-Ro I: Parietal cell
centromere mitochondrial phospholipid
antibodies antibodies cytoplasmic antibodies antibodies antibodies
antibodies antibodies antibodies
antibodies
Blood in urine
• A 59 year old man complaining of sudden onset of
severe pain in his left loin associated with visible
haematuria. He returned from a holiday in Africa
yesterday.
• For each patient, what is the most likely diagnosis?
• A: Bladder cancer
• B: Glomerulonephritis
• C: Kidney stone
• D. March haematuria
• E: Prostatitis
• F: Renal cancer
• G: Urethritis
• H: Urinary tract infection
Blood in urine
• A 19 year old man presenting with weight loss. On
examination, he has a left varicocoele and visible
haematuria.
• For each patient, what is the most likely diagnosis?
• A: Bladder cancer
• B: Glomerulonephritis
• C: Kidney stone
• D: March haematuria
• E: Prostatitis
• F: Renal cancer
• G: Urethritis
• H: Urinary tract infection
How to prepare for it?
• For FY1/2 – do a general set of jobs
• GP, A&E, General Medicine (Acute Medicine/
Geriatrics)
• Start early!
• Be engaged at work! Read things up if you don’t know
• Question banks
• Passmedicine for content knowledge
• Samson/ MCQbank for clinical knowledge and
questions – especially samson mocks are very
representative
• MCQBank and MSRA official mocks for
professional dilemmas
• A lot of people just “have a go at it”/ “apply to see
what happens”
• Put in the hard work and you will be ok!
