Current MSRA structure
NHS England currently describes the MSRA as a 170-minute computer-based assessment with two independently timed components.
95 minutes · 50 scenarios
Up to 5 minutes before CPS
75 minutes · 86 items
Format and recruitment arrangements can change. Confirm the details for your own application round using the official structure page and NHS England MSRA overview.
What this means for pacing
Both papers require sustained concentration and leave limited time for long internal debates. Develop a steady first-pass pace, answer every item, and use flags selectively. A flag is useful when you have identified a difficult point to reconsider, not as a holding area for every hard question.
- Practise each component alone before combining them.
- Move from untimed learning to timed sets, then full simulations.
- Learn how fatigue changes your decisions in the second paper.
- Use the optional break deliberately: reset, breathe and return on time.
A preparation plan between now and the exam
Establish the baseline
Sit a mixed set without notes. Separate gaps in knowledge from errors in interpretation, judgement and timing.
Repair weak areas
Use focused revision and shorter question sets. Keep a compact error log containing rules and decisions, not copied explanations.
Build exam pace
Increase timed work. Practise committing to a best answer when several options remain plausible.
Simulate the full sitting
Complete full CPS and PD papers with the scheduled break and no external help. Review the paper only after finishing it.
The review session matters more than the score
An isolated percentage tells you very little. A useful review identifies what you will do differently next time. For every error or uncertain correct answer, decide whether you lacked knowledge, missed a clue, chose the wrong stage of management, misjudged proportionality or ran out of time.
Write one transferable lesson per question. “In a suspected PE, start treatment before awaiting imaging if there will be a delay” is more useful than copying a paragraph about one condition.
During the final week
- Confirm your booking, identification requirements and test arrangements.
- Avoid rebuilding your entire revision system.
- Complete enough timed work to keep your pacing familiar, but leave time to review.
- Protect sleep and arrive with a plan for the optional break.
- Remember there is no negative marking: submit an answer for every question.
Use resources for different jobs
Guidelines and notes repair knowledge. Short question sets develop recognition. Full mocks train pacing, concentration and switching between CPS and PD. Do not expect one resource to do all three jobs equally well.