Practice and review

Start with the official practice paper

Use the official MSRA practice paper with answer keys and expert rationales. Attempt the questions before reading their explanations. Avoid copying question-bank text into a shared library; record the source and question identifier instead.

Start without a time limit. For ranking questions, explain why each action sits above the next. For choose-three questions, explain what each choice contributes. This helps you spot gaps in your reasoning even when you’ve chosen the right answer.

Learn from a question you got wrong

Use the explanation to work out what to try next:

Error	What to change next time
Misread the instruction	Identify format and ranking direction before answering.
Missed a stem fact	Write a one-sentence account of risk and responsibility.
Invented a fact	Separate stated facts from assumptions.
Ranked actions by the order I’d take them	Reassess each action independently.
Misjudged proportionality	Compare seriousness, urgency and the purpose of escalation.
Confused similar wording	Check the verb, recipient, timing and condition.
Chose a weak set of three	Check coverage and compatibility of the whole set.
Unfamiliar system or terminology	Use the glossary, IMG guide or relevant official source.
Remains ambiguous	Preserve the uncertainty and seek a reliable rationale.

If you reversed a ranking pair, write down the fact that explains the preferred order. If you missed a choose-three answer, compare the correct option you left out with the one you chose instead. What need did your choice leave unresolved?

Do not turn one explanation into an absolute rule. Record when the lesson applies and one fact that would change it.

Move to timed practice

The standard paper’s 95 minutes for 50 scenarios gives an average of about 1 minute 54 seconds per scenario. That’s an average, rather than an official limit for each question. You might reserve 5 minutes for review, leaving about 1 minute 48 seconds per scenario on the initial pass. Adjust your plan to your pace and any approved timing adjustment.

Complete each answer before moving on. If the interface permits review, flag uncertainty and return while time remains. Change an answer when you identify a missed fact or a specific reasoning error; feeling unsure alone doesn’t give you a reason to change it.

Before the exam, try the test provider’s generic demo, linked from NHS England’s structure page, to get used to the controls and screen layout.

The optional break between papers is 5 minutes. NHS England states that any extra time taken is deducted from the Clinical Problem Solving paper.

Revising with others

Group study and discussing practice material are fine. NHS England states that sharing information about the actual assessments is unacceptable and viewed as unprofessional behaviour. The MSRA also uses different versions of the paper designed to be equivalent, so knowing one paper’s questions won’t necessarily help with another.

Measure something useful

Track recurring error categories and whether you can apply a lesson to a fresh scenario. A familiar answer can show what you remember, but a fresh scenario helps you check whether you can apply the reasoning. Scores on this guide’s teaching examples can’t predict your MSRA result.

If a commercial key conflicts with an official rationale, compare the exact wording and facts first. If the conflict persists, note what remains uncertain. You don’t need to invent a universal rule to make both answers fit.