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The MSRA exam is a mandatory part of the application for ophthalmology specialist training in the UK. It is a computer-based exam which is designed to assess junior doctors with foundation level competence. It is used for entry to postgraduate training in ophthalmology as well as a number of other different specialities (for example, radiology, obstetrics and gynaecology).

After application to speciality ophthalmology training, all candidates who are long-listed are required to sit the MSRA exam. The MSRA results are used to select the number of applicants who are invited to the interview stage. An overall application score is formed from a candidates’ MSRA, portfolio and interview scores. In 2021, the MSRA accounted for 20% of the overall application score.

Sitting the exam

The MSRA is a computer-based exam which is two hours and 55 minutes in length and is free of charge to sit. The exam is sat in one of the Pearson Vue centres across the country on one of the days within the allocated examination window (usually at the end of January to the beginning of February). You are notified through Oriel and asked to create a Pearson Vue account if you are long-listed. An examination slot can be booked at one of the centres as soon as you are notified on a first come first serve basis.

On the day you will need to arrive at least 15 minutes before your scheduled start time and bring one form of valid government issued identification, e.g. passport or driving license.

Exam structure

There are two parts to the exam, the professional dilemma section and the clinical-problem solving section. Throughout both parts you are expected to assume the role of a Foundation Year 2 doctor (FY2). You have a scheduled five-minute break between the two sections of the exam. If you take other breaks outside of this time you will not receive any additional time.

The professional dilemma section is a situational judgement test and is designed to assess your understanding of situations that arise at work as a junior doctor and your response to these. It assesses professional attributes thought to be important for successful progression through training. You are expected to respond to the situation with how you think you should behave as an FY2 doctor. The dilemmas cover three domains: professional integrity, coping with pressure and, finally, empathy and sensitivity. There are 50 questions, with 42 counting towards the overall mark, as eight are pilot questions. For this part of the examination you have 95 minutes allocated. The questions are a mix between ranking answers in order and multiple-choice questions.

The second section is clinical problem solving and measures the applicant’s ability to apply their knowledge and make clinical decisions. This is again based on foundation doctor level competency and covers 12 topic areas related to general medicine. There are only a small number of ophthalmology questions, and therefore revision must be broad to cover other speciality areas. The questions are clinical scenarios which require you to use judgement and problem-solving skills to diagnose and manage conditions. It comprises of 97 questions, of which 86 count towards the overall mark and 11 are pilot questions. You are allocated 75 minutes to complete this section. The questions are either extended matching questions (EMQ) or single best answers (SBA).

Exam marking

For each item, one mark is awarded for choosing the correct response. In the professional dilemma questions that ask you to rank answers in order, answers are marked against a pre-determined key which is based on a near miss approach. There is no negative marking.


Ensure that you allocate around three to three months to revise for the exam (if you are revising alongside full-time work). Cover the medical topics outlined in the clinical problem-solving section and practice example questions using online question banks.

For the professional dilemma section familiarise yourself with the General Medical Council (GMC) guidelines and good medical practice. The ethical hub on the GMC website has ethical scenarios you can work through which can help to understand how to apply these guidelines into practice. Health Education England has a sample of professional dilemma questions with answers and explanations which you can practice. The exam can be time pressured, so it is important to practice timed examinations prior to the day. Once your allocated time for the first professional dilemma section is up, you cannot revisit these questions.

Although various books do exist for the exam, many candidates prepare adequately with just the resources mentioned above. Many courses do also exist for the exam. Every candidate will be different, and a combination of these resources may be required.



Online question banks

There are multiple online question banks available, which often require an initial subscription payment. In Table 1 I have compared the most popular online question banks, including their advantages and disadvantages to help you to decide which to choose when preparing for your upcoming exam.

It is important to practice online questions as much as you can to familiarise yourself with the format, and to ensure you cover the broad range of specialties included in the exam. Often candidates complete online question banks more than once prior to the exam (either the same bank, or they sign up to multiple banks) alongside other revision. Using question banks is a good way to test your knowledge and to highlight areas for improvement.

Although useful for the clinical knowledge questions, it is important to be cautious when using online question banks to practice the professional judgement questions. Answers and explanations tend to vary significantly between different question bank providers, and may not accurately reflect the actual questions presented in the exam. Familiarising yourself with online GMC guidance, and practising the official practice papers is a more useful revision technique.

Doing well on the MSRA exam can boost your overall ophthalmology application score, so it is well worth spending time preparing for. Some of the resources I found useful are listed below. Good luck!




  • Book your exam early to give yourself the best chance of securing your chosen Pearson Vue centre and time
  • Use the online Pearson Vue tutorial to familiarise yourself with the online format of the exam
  • Read the questions carefully
  • Remember they are expecting you to be at the level of an FY2 doctor
  • Answer every question, there is no negative marking!
  • Sleep well the night before, ensure you have eaten and drunk water prior to the exam as you are not allowed any food or drink in the exam room
  • Aim to complete two to three months of revision supplemented with an online question bank for the clinical problem-solving section – try to complete the question bank at least once



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Lois Crabtree

Epsom and St Heliers Hospital, UK.

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