The MSRA is a computer-based specialty recruitment assessment with two papers, Professional Dilemmas and Clinical Problem Solving, delivered through Pearson VUE centres. For 2026 entry it was used by 11 specialty routes, including GP ST1 and Core Psychiatry CT1. In recent GP recruitment rounds, offers and deanery allocation have been determined by MSRA score, with no separate interview stage, according to NHS England recruitment guidance; the same 2026 guidance placed Core Psychiatry CT1 under that selection arrangement.
For GP and Core Psychiatry, the score determines rank after eligibility checks. Other specialties use it differently, so the rules for the chosen programme matter more than the fact that its name appears on the MSRA list.
Which specialties require it for 2026 entry
NHS England's 2026 MSRA overview lists these programmes:
- Acute Care Common Stem Emergency Medicine, commonly called ACCS EM, at CT1 or ST1
- Anaesthetics CT1
- Clinical Radiology ST1
- Community Sexual and Reproductive Health ST1
- Core Psychiatry CT1
- Core Surgical Training CT1
- General Practice ST1
- Neurosurgery ST1, ST2 and ST3
- Nuclear Medicine ST3
- Obstetrics and Gynaecology ST1
- Ophthalmology ST1
The national variants matter too. The 2026 overview separately included Northern Ireland routes for Core Surgical Training CT1, Clinical Radiology ST1, Core Psychiatry CT1 and Emergency Medicine ST1, plus Scotland's Broad Based Training ST1. A candidate should therefore read the guidance for the exact nation, specialty and recruitment round rather than assume that one MSRA rule applies across all 11 routes. The weighting changes the meaning of the same score. NHS England's 2026 specialty recruitment guidance placed GP ST1 and Core Psychiatry CT1 under a no-interview selection arrangement. For these routes, the MSRA score supplies 100% of the selection ranking, after eligibility checks.
Core Surgical Training shows the opposite end of the range. The MSRA first formed the shortlisting score, but the 2026 Core Surgical Training guidance weighted it at only 10% of the final score. The portfolio station carried 45% and the management and clinical station carried the remaining 45%. A poor MSRA result could prevent an interview, yet a high result could not replace a weak portfolio and interview.
For the other specialties, the MSRA may be a shortlisting filter, part of a combined score or a route to an interview. The 2026 NHS overview explicitly directs applicants back to specialty guidance because details differ. “Requires MSRA” therefore does not mean “MSRA decides everything”. GP and Core Psychiatry are the important exceptions.
The Band 1 rule
For GP recruitment, NHS England reports paper results in 4 bands. Band 1 means that the minimum acceptable standard was not achieved. The GP MSRA scoring page states the consequence plainly: Band 1 in either paper makes the application unsuccessful, regardless of the other paper or other factors.
That is an automatic application rejection, not a small scoring penalty elsewhere.
That “either paper” condition deserves attention. A candidate cannot compensate for Band 1 in Professional Dilemmas with an exceptional Clinical Problem Solving result, or the reverse. The first preparation target is therefore a safe floor in both papers. Only after both are reliably above that floor should rank optimisation become the dominant aim.
Bands are broad performance categories, not two independent pass certificates that can be treated casually once Band 1 is avoided. For GP and Core Psychiatry, every improvement above the minimum can still change rank because 2026 selection had no separate interview score to absorb a weaker MSRA result. Passing the floor keeps the application alive. Ranking determines whether, and potentially where, it succeeds.
When it comes after PLAB
Preparation and eligibility have different timelines. The current person specification and Oriel instructions govern registration status and evidence deadlines for each specialty and recruitment year. In the 2026 cycle, Round 1 applications opened on 23 October 2025. NHS England scheduled a January 2026 sitting for applicants across all MSRA specialties, then a February 2026 sitting reserved for Core Psychiatry and GP applicants. Recruitment capacity controlled allocation between windows; the later date was not available by preference.
Clinical revision can begin before an Oriel application or Pearson VUE invitation, once the intended specialty and cycle are clear. Professional Dilemmas also requires familiarity with UK workplace judgement rather than a list of recalled answers. Doctors still preparing for PLAB 2 need to balance that work against the exam immediately in front of them; the PLAB 2 preparation plan covers that stage.
Why the Prioritisation Act raises the stakes
The Medical Training (Prioritisation) Act changed the order in which appointable candidates received specialty offers in 2026. NHS England's outcome data reported that priority candidates filled 98% of posts, up from 72% in 2025. Accepted offers to non-prioritised applicants fell from 2,168 to 163 in one annual cycle. The effect on IMGs was severe, not theoretical. Priority and selection rank are separate layers. For 2026 recruitment, the Act applied prioritisation at the offer stage, while specialty performance still generated the rank. An IMG who becomes a priority candidate through Foundation completion is considered within the priority group, but still needs a competitive MSRA score. The full guide to IMG training prioritisation explains who qualified in 2026 and how the rules extend from shortlisting through offers from 2027.
For GP and Core Psychiatry, priority status and selection rank answer different questions. Priority determines how the application is treated under the Act; MSRA performance orders applicants within the selection process. Meeting the priority definition does not guarantee an offer. NHS England recorded 33,953 appointable applications for 9,315 specialty posts in 2026. These are applications, not individual doctors, and the overall ratio does not give a person's chance of appointment.
Preparing for the two papers
The two papers reward different habits. NHS England describes Professional Dilemmas as a situational judgement assessment set in an F2 context. Candidates rank actions or choose appropriate responses to workplace scenarios, using principles consistent with GMC Good Medical Practice: patient safety, honesty, escalation, confidentiality, teamwork and recognition of personal limits. Professional Dilemmas is where PLAB 2 transfer is weakest. PLAB stations reward safe communication and escalation, but they allow a candidate to explain a plan aloud and respond to a patient or colleague. The MSRA asks for a fixed ranking or selection among plausible actions. Several options may sound reasonable, and the task is to identify the order that best fits an F2 doctor's responsibility in the NHS.
Preparation for Professional Dilemmas should include explaining why each option fits or conflicts with the facts and with current professional standards. Memorising an answer key is unreliable when a change in risk, responsibility or available support changes the appropriate response.
Clinical Problem Solving assesses applied clinical knowledge and decisions at Foundation, specifically FY2, level. This is not a PLAB recall paper under another name. It asks a candidate to move from a short presentation to the most likely diagnosis, investigation, emergency response, prescription or management choice. PLAB 2 clinical reasoning transfers here, especially the habits of recognising red flags, choosing a safe next step and avoiding unnecessary delay. The gap is breadth and speed. An OSCE station develops over a conversation, while a computer-based CPS item demands a precise decision from compressed information. Revision must cover common presentations across general medicine rather than only cases that fit PLAB 2 station practice.
ProMSRA by GK provides a separate CPS question bank for applied Foundation-level practice. Its Professional Dilemmas course sets out an IMG-focused judgement framework and practice route for the PD paper. These are preparation tools, not recruitment authorities; NHS England's current specialty pages and Oriel messages remain the sources for rules and dates.
A study order can start with a baseline in both papers, because the Band 1 rule makes a hidden weakness important. The next block can give more time to the lower paper while keeping regular practice in the stronger one. In the final stage, mixed timed sets can alternate with error review: every CPS error needs a clinical reason, and every PD error needs an explanation of why another action was safer, more direct or more proportionate.
Questions candidates actually ask
Do IMGs have to sit the MSRA?
No. An IMG sits the MSRA only when applying to a specialty that uses it, such as GP ST1, Core Psychiatry CT1 or one of the other listed 2026 programmes. Nationality does not create a separate MSRA requirement.
Is GP training really decided only by the MSRA?
In recent GP recruitment rounds, offers and deanery allocation have been determined by MSRA score, with no separate interview stage. Applicants must still satisfy eligibility requirements, and a Band 1 result in either paper makes the GP application unsuccessful.
Can you sit the MSRA before full GMC registration?
Registration and evidence requirements depend on the specialty and recruitment year. PLAB-route applicants should check the current person specification and Oriel deadline rather than assume that passing PLAB or starting a service job is enough.