Format and expectations
The formats, the skills and a way to approach your preparation.
Read the video transcript
The Multi-Specialty Recruitment Assessment has two papers: Clinical Problem Solving, and Professional Dilemmas. This guide focuses on Professional Dilemmas.
The Professional Dilemmas paper contains fifty scenarios. Roughly half ask you to rank actions. The other half ask you to choose three.
In ranking questions, put four or five independent actions in order, from most to least appropriate. Compare what each action would actually achieve.
In choose-three questions, select three actions from eight options. Your choices should work together, so consider the combined response rather than three isolated answers.
The paper assesses professional integrity, coping with pressure, and empathy and sensitivity. Several options can sound reasonable. Look closely at the differences.
Ask whether an action fits the problem, what it changes, and whether it stays within your role. Consider avoidable harm, and explain your reasoning. These are study prompts, not an official scoring system.
Start with the format, then practise comparing actions. Explain what each response achieves, and what it misses. Build your professional judgement with Wardwise.
Where this guide fits
The Multi-Specialty Recruitment Assessment (MSRA) has two papers: Clinical Problem Solving and Professional Dilemmas (PD). This guide focuses on PD, the Situational Judgement Test that asks how you should respond to challenging professional situations.
You’ll often recognise something useful in more than one answer. The work is deciding which action best fits the facts, your responsibilities and the people affected.
Work through the guide as a connected set of lessons. The method chapters give you a routine for reading and comparing. The topic chapters show how professional principles apply in different situations. The worked examples let you practise that routine, with annotations that reveal the reasoning as you go. Return to the relevant lesson when a question exposes a gap.
What the paper asks you to do
The PD paper contains 50 scenarios. Roughly half ask you to rank actions; the other half ask you to choose three.
- Ranking: order 4 or 5 independent actions from most to least appropriate. You can earn marks for a partly correct order, depending on how closely it matches the official answer key.
- Choose three: select 3 actions that work together, from 8 options.
There’s no negative marking, so attempt every question. The paper assesses 3 areas: professional integrity, coping with pressure, and empathy and sensitivity.
The standard PD time is 95 minutes. The full MSRA also includes a separately timed 75-minute Clinical Problem Solving paper, with an optional 5-minute break between them. Check the current arrangements for your sitting and any approved adjustments.
NHS England also states that:
- the best response is always among the options;
- each item contains a mixture of good, acceptable and poor responses, as judged by subject matter experts;
- completely implausible responses are not included, so expect most options to sound reasonable;
- scenarios are set across hospital wards, general practice, out-of-hours clinics and occasionally non-medical contexts, but the setting only provides context and the judgement is not setting-specific;
- items are reviewed to avoid requiring knowledge of local or very UK-specific procedures or policies.
In the official practice paper, assume you’re a doctor in the second year of Foundation training (F2) unless the scenario specifies otherwise. Answer what you should do in the described role, using the information given. The shortened practice paper has its own timings; those are not the full assessment timings.
What to practise
Look at what each action would actually do. “Be empathetic” is too broad to help you compare options. “Ask what’s worrying this patient before proposing a solution” gives you something specific to judge.
For each option, examine:
- Fit: does it address the problem actually described?
- Effect: what changes for the patient, colleague or service?
- Limits: is it within your role, and does it get help where needed?
- Possible harm: could it cause avoidable delay, disclosure, conflict or risk?
Use these questions to explain your reasoning. They aren’t a points system for predicting the official answer.
A response can be partly helpful and still rank below another response. Even the least appropriate option may sound reasonable at first. Compare it with the alternatives to find what it misses or gets wrong.
References
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