The Specialty Recruitment Assessment (SRA) – what to expect and how to prepare

The Specialty Recruitment Assessment (SRA) plays in important part in the shortlisting and assessment process for 8 different specialties: GP, Radiology, Ophthalmology, Obstetrics and Gynaecology, Psychiatry, Neurosurgery, Child and Adolescent Mental Health Services (CAMHS) and Community Sexual and Reproductive Healthcare (CSRH). It is also known as the Multi Specialty Recruitment Assessment (MSRA).

It will be done entirely on computer, and consists of two parts lasting a total of 3 hours 5 minutes – a clinical problem solving section and a professional dilemma section. Each specialty uses the results of the SRA in a slightly different way in the recruitment process for ST1 / CT1 posts – in most cases, the score is used both to shortlist for interview / selection centre, but also carries over and makes up a part of your overall ranking (the rest coming from interview / selection centre). For applicants to GP or Psychiatry, an exceptional score (~top 10%) can lead to a direct offer without needing to attend the next stage.

Clinical Problem Solving


This is a 75 minute assessment with 97 questions testing your clinical knowledge and ability to apply it in practice.  This paper is set at the level of knowledge expected for a Foundation Year 1 doctor at the END of their first year.  The paper is very broad, covering almost all the medical and surgical specialties.  There are a variety of question types, including:

  • Extended matching questions (EMQ)
  • Single best answer (SBA)
  • Multiple best answer (MBA) – there are up to 3 correct answers
  • Picture questions – this could include skin lesions, fundoscopy, blood reports, ECGs etc.
  • Algorithm questions – you may have to drag boxes into the right part of the algorithm or select the correct answer from a list. Algorithms could include BLS / ALS / important guidelines etc.

Question may relate to diagnosis, investigation or management of both common and important diseases as well as rare but serious presentations.

There are some example of the 2 most common question types (EMQ and SBA) below:

EMQ – Investigations for back pain

1. A 25 year old man is involved in a road traffic accident. He was on a bike and hit from the side. He did not want to attend the hospital, and was taken home by his friends. He now complains of severe pain in his lower back and cannot pass water. He has tingling in his legs below the knee. Select the most suitable investigation from the list.

A X-ray of the lumbar spine E Routine MRI scan lumbar spine
B X-Ray of sacro-iliac joints F Urgent MRI scan lumbar spine
C Routine CT scan lumbar spine G DEXA scan
D Urgent CT scan lumbar spine H No investigations needed

2. A 68 year-old woman with known osteoporosis. She has had a fractured neck of femur in the past after a fall in her garden. She now complains of pain in her lower back, but does not have much muscular tenderness. She has no bowel or bladder symptoms. She has no neurological symptoms. Select the most suitable investigation from the list.

A X-ray of the lumbar spine E Routine MRI scan lumbar spine
B X-Ray of sacro-iliac joints F Urgent MRI scan lumbar spine
C Routine CT scan lumbar spine G DEXA scan
D Urgent CT scan lumbar spine H No investigations needed

3. A 40 year old labourer attends complaining of severe low back pain after finishing his shift. He does not have any bowel or bladder problems, and on examination has a straight leg raise of 90 degrees in both legs. He has no other significant medical history. Select the most suitable investigation from the list.

A X-ray of the lumbar spine E Routine MRI scan lumbar spine
B X-Ray of sacro-iliac joints F Urgent MRI scan lumbar spine
C Routine CT scan lumbar spine G DEXA scan
D Urgent CT scan lumbar spine H No investigations needed

SBA – Allergic reactions

4. A 35 year old man has a severe allergic reaction while in hospital. He has no history of past allergic reactions. Which ONE of the following is most likely to cause a reaction WITHOUT prior exposure or sensitization? Select ONE answer only.

A. Peanuts

B. Hymenoptera stings

C. IV Penicillin

D. IV Contrast media

E. Latex

Answers and explanations are available at

Click the image below for details on how to access over 2000 realistic exam level questions to help you prepare for both papers in the SRA.

Professional Dilemma paper

Businessman looking at arrows pointed in different directions

This is a 110 minute assessment with 58 situational judgement test questions (SJT). Questions test judgement and decision making in a workplace context. It also assesses knowledge of important ethical and medicolegal guidance from the GMC. Questions assess 3 domains – empathy and sensitivity, coping with pressure, and professional integrity.

There are two types of SJT questions in equal proportion. The questions in section 1 ask you to rank 4 or 5 actions from best to worst in the context of a workplace scenario. The questions in section 2 ask you to select 3 actions that taken together make the best response to the situation. There are up to 8 options to select from in this type of question.

Sample ranking question:

You have just started a job as a medical F2 in a new hospital. Your partner has a chest infection, and is not yet registered with a GP and has asked you to prescribe antibiotics.

Rank the following options 1-5, 1 being the most effective / best option, 5 being the least effective / worst option:

A. Prescribe the medication as a private prescription, and arrange for your partner to register with a GP the following week.

B. Tell your partner to register with a GP locally.

C. Prescribe the medication on a hospital take home prescription with your partner’s details on it.

D. Prescribe the medication on a hospital take home prescription with one of your patient’s details on it.  Collect the medication from the hospital pharmacy.

E. Pressure one of your FY1 colleagues to write a prescription on a hospital take home script without seeing your partner.

Sample selection question:

You are an F2 in Orthopaedics. An 80 year old lady has a fracture of her right neck of femur. You have been asked to consent her prior to surgery but on talking to her she seems confused. Her daughter tells you she has dementia and this is confirmed in the notes.  She is first on the morning list.  Select the THREE most appropriate actions to manage this situation:

A. Ask her daughter to sign the consent form and state that she is the daughter.

B. Inform your consultant she has dementia and ask him to complete the consent form.

C. Encourage the patient to sign the form as the procedure is in her best interests.

D. Exclude any acute causes that could be worsening her confusion.

E. Discharge the patient as she will be unable to have surgery without consent.

F. Cancel the patient’s operation.

G. Ring the theatre to rearrange the list so this lady is lower down on the list.

H. Complete the consent form on the patient’s behalf as it is in her best interests.

Answers and explanations are available at

Preparing for the SRA

It is important to allow enough time to prepare for both papers – some specialties use the scores as part of a ranking process to determine eligibility for interview / selection rather than as a pass / fail criterion. In most cases the SRA score carries over to the next stage and is added to the interview score to determine overall rank so it is important to do as well as possible. Try to combine reading to cover the key clinical theory (Oxford Handbook of Clinical Medicine and Oxford Handbook of Clinical Specialties) and understand key GMC ethical guidance with practising sample SRA questions to develop exam technique and get a feel for the different types of questions. As you get nearer the time of the exam, you will benefit from doing a timed mock exam to get used to the pressure of the exam.

I hope this article has given you a clearer understanding of what to expect in this important assessment. I wish you every success with your revision and in getting a place on your chosen rotation.

Dr Mahibur Rahman is medical director of Emedica, and has helped thousands of doctors prepare for this type of assessment since 2007. He teaches on the popular Specialty Recruitment Assessment Crammer course which covers both papers. You can get a £20 discount on the course which carries 6.5 CPD credits by using the code srapass at 

Specialty Recruitment Assessment (SRA) tips from a high scorer – how I got a direct offer for my 1st choice rotation

The Specialty Recruitment Assessment (SRA) is used by various specialties as part of the recruitment process for training posts. It has been used longest for GP training. In this article, Dr Amelia Thompson explains how she got a score high enough for a direct offer while juggling studying with caring for 2 young children and working in Malawi!

I applied for GPST in 2012 in my FY2 year, scored band 3 for both papers at stage 2, but was unsuccessful at the Selection Centre. I had heard it was easy to pass, so I felt pretty confident and didn’t do too much preparation. Naturally I was devastated. General Practice was all I really wanted to do. However, my husband had just been offered a job internationally, so I decided to take some time out of formal training, and get some more experience through volunteering. The planned one year away turned into five, we started a family, and I worked in public hospitals in Rwanda and Malawi. However, I was keen to reapply for General Practice and aimed for the August 2017 intake.

I signed up to the Pastest question bank 5 months before the January exam- I knew I would have to start preparing early with 2 children under 3. I slowly worked my way through the question bank, doing about 2-3 hours a week and making notes of and rehashing weak areas. We were still living in Malawi and our internet was terrible, so I managed to get hold of a few books of practice questions from Pastest and ISC Medical.

By the beginning of December I realized I hadn’t really made much progress and was still achieving the same average score when doing the mock exams. I really wanted to qualify for the Direct Offers Pathway. As we were still in Malawi, travelling back for the Stage 2 already meant leaving the family behind (my youngest was 12 months and still nursing), doing an overnight flight, arriving the day before the exam, doing an Emedica course for stage 3, and flying back again the following day. I REALLY didn’t want to have to travel back twice in a 4 week period, but I just didn’t think I could compete to get into the top 10% that went straight through to a direct offer.

So I started doing 3 hours of revision a day. I was at home with the kids at this stage so I managed to do an hour at lunch while they were napping and then 2 further hours in the evenings. Daily. I took a 3-day break for Christmas and that was it for 6 weeks until the exam. I did about 200 questions per day, would make a note of the key areas to revise, and at the end of each set of specialty questions I would write notes (using screenshots of answers, NICE guidelines, Patient UK professional reference, Emedicine, etc). I worked my way through the entire question banks of Pastest, Emedica, and BMJ On Examination, and then I started again, doing all the ones I had answered incorrectly, and then again for the ones I had got wrong a second time! And when I had done that I did mock exams for the last week, and went over and over my revision notes. By the beginning of January I was scoring about 85-90% on mock exams but I still didn’t think this was high enough to qualify for Direct Offers. So I just resigned myself to doing as best I could and praying a lot! I scored a total of 610, qualifying for direct offers, so I am thrilled to have got this far and hopefully will get my first choice job!

Some tips for SRA revision:

  1. Don’t underestimate the difficulty of the SRA, start studying early, and do as many questions as you can afford to. It will pay off.
  2. All the question banks were good, and it is great to get used to as many formats as possible. Emedica was the closest in format and wording to the actual exams and the mock exam papers have questions that are not included elsewhere in the bank.
  3. Work through one specialty at a time- questions follow common themes and the repetition will help consolidate your learning. Aim to go back over the ones you answered incorrectly within 3 days- you’ll be surprised how easy it is to get them wrong again and doing it within this time frame will help it stick!
  4. For the SJT, you just need to practice, and practice some more- you will start picking up on subtle wording differences that will make prioritisation so much easier.
  5. When you start doing timed papers, make sure you do a few sessions with the 2 papers back to back. I was not expecting the SJT first in the exam, and that threw me. I was nearing the end of my concentration by the end of the clinical one- so get used to doing a 3-hour exam.
  6. Do lots of timed papers. I was expecting to have at least a 20-minute window at the end of each paper to check them through but in the exam this was more like 7-10 minutes.

Tips for the exam:

  1. If you are travelling a long way Pearson locations around Heathrow and other airports get booked up quickly, so act fast!
  2. Get there early, or consider staying in a hotel nearby the night before. Walk to the test centre before the exam, partly to clear your head and calm nerves. They may let you book in earlier than your slot too, so it’s worth deciding if you want to do that.
  3. Double check your appointment and ID the night before.
  4. Take some water and a non-messy, non-salty snack with you- you’ll be able to pop out for a short break if you have time.
  5. If you come out of the exam feeling it was awful, don’t give up hope!! I came out of the SRA thinking I had probably got about 60%, based on my experience of the mock exams. You probably did better than you think!
  6. If you don’t qualify for the Direct Offers Pathway, DO THE EMEDICA GP STAGE 3 REVISION COURSE. I did it immediately after the SRA because I couldn’t afford to travel back before the stage 3 yet again. I failed the stage 3 Selection Centre 5 years ago, and after the doing the course now I can not only see why, but also without it I just wouldn’t have had a clue as to what the examiners were looking for! Good Luck!

Dr Amelia Thompson scored 610 (~top 1% in the country) and got a direct offer in her 1st choice area. She started GP ST1 in August 2017.

You can find out more about the Emedica online revision service for Stage 2 and get a 10% discount by using the code srapass at

Talking to relatives – what to say and how to say it

Talking to the families of your patients can be one of the more difficult parts of your life as a doctor, but you can make it one of the most rewarding. It is part of everyday life for doctors to be asked to discuss a patient’s care with a relative or carer. In this article, Dr Mahibur Rahman looks at some key things that can really help, whether you are breaking bad news or just updating the family on management plans.

Be prepared

You need to be fully aware of all aspects of the current situation before beginning a discussion with a family – incorrect information can produce problems later on. Arrange a time (even if it’s only five minutes later), and go over the case notes to remind yourself of exactly what has happened, what is happening now and what is going to happen. If you are breaking the news of a patient’s death, make sure you know as much about the events surrounding the death as possible (cause, time, people present etc.). Consult with other members of the team (especially nursing staff). If possible, ask someone to hold your pager while you deal with the relatives. Make sure you get permission (where appropriate) from the patient to discuss their care with relatives.

Set the scene

It is essential that any discussions take place in a suitable environment – ideally a quiet side room or office where you won’t be disturbed. Holding a discussion around the bed is very rarely a good idea. There should be adequate seating for everyone. Standing when you are talking to someone can give the impression that you don’t have much time, and need to rush off somewhere else. Try to bring a member of the ward staff with you – someone who can stay afterwards and explain or reinforce anything that you said.

What to say.

Honesty is one of the factors that relatives values the most when dealing with doctors. They need the truth to make their personal adjustments and their plans. Make sure that you do not stray from the facts, and if you are unsure about something, NEVER make it up. Instead, offer to find out and leave the details with the ward staff, or arrange another meeting.

How to say it

At all times, be polite and patient. Remember that the family will be under great strain. Explain things in language that the relatives can understand, avoiding medical jargon as much as possible. The relatives are much more likely to understand “your father has had a stroke”, than “the CT scan has shown an ischaemic CVA”. Where the family have a grievance about anything do not be defensive and never raise your voice – this will make the situation worse. An apology a day keeps the lawyers away.

Say it again, Sam

You may have to explain things more than once, and relatives sometimes have their own ideas about what is going on. Allow them to air their concerns. Always ask if they would like you to go over anything, and offer them a chance to ask questions. The wording of this is very important – saying “is there anything I haven’t explained clearly?” is better than “is there anything you didn’t understand?”. Although having essentially the same meaning, the first does not demean the relatives in any way, where the second might be taken as an insult to their intelligence.

And in the end.

Finally, leave a means of contact if they want to follow up your discussion – this can be by leaving a message with the ward clerk or a member of the nursing team, or via your pager (only give this out if you genuinely don’t mind relatives bleeping you – it is usually better to call them so that you are properly prepared for any conversation).

You will find that family members are often very grateful for the time you take to discuss their relative’s care. And doing this well will give a huge boost your job satisfaction.


Here are some of the keys to successfully dealing with family members or carers.

  • Look and speak the part
  • Make sure you know the case well – read over the notes carefully
  • Turn off your phone and hand over your bleep so you aren’t disturbed
  • Use a quiet room with adequate seating
  • Explain the facts clearly, avoiding medical jargon
  • Offer to go over diagnoses and management
  • Leave time for relatives to ask questions
  • Offer to find out things you don’t know
  • Make notes and record what was said in the patient’s notes

This article has been adapted from one first published in Februray 2005 and is reproduced with the kind permission of Hospital Doctor, who retain the copyright.

GP ST Selection Centre / Stage 3 Assessment Preparation – Tips

For those of you that get to the Selection Centre / Stage 3 Assessment for GP ST entry, here are a few helpful tips on what to expect.

All deaneries use the same national format for Stage 3 Assessments. This consists of a 4 part assessment. These include:

Simulated consultation with a patient
Simulated consultation with a relative / carer
Simulated consultation with a colleague
Written prioritisation exercise

The consultations last 10 minutes each including reading time, and the written exercise lasts 30 minutes. All 4 parts are equally important.

The selection centre is designed to assess the following competences throughout the different assessments:

  • Empathy and sensitivity
  • Communication skills
  • Conceptual thinking and problem solving
  • Professional integrity

Written prioritisation exercise

This typically gives you a list of things that need to be addressed (usually 5), and asks for you to list them in order of importance / priority, and then to give justifications and to describe the actions you would take. There is no one right answer / order, so it is important NOT to get hung up on that. Usually there is at least one that is clearly of high clinical importance. It is important to discuss both your REASONING and justifications, and what actions you would take in detail. Answers should relate to the competencies being tested, and be specific to the information provided and in what you would do. A good answer will have a good number of points for each of the 5 tasks to be addressed and show positives for all the competences being assessed. Written communication including spelling, punctuation and grammar as well as structured explanations are assessed in this task.

Simulated consultations

You will do 3 different simulated consultations – 1 with a patient, 1 with a relative or a carer, and 1 with a colleague.

shutterstock_391358626The simulated consultations could include various communication issues – an ethical scenario, breaking bad news, explaining an investigation or diagnosis, etc. In these cases, remember the basics will get you some easy marks – introduce yourself, try to establish rapport, ask about the other person’s Ideas, Concerns and Expectations. Check their understanding and try to be person centred.

Clinical knowledge is not being assessed, however if you demonstrate a clear lack of basic clinical expertise, or tell the patient something that is clearly unsafe, this may affect your overall mark.

The role players are not there to assess you – the examiner will be either a GP trainer or a consultant, however they do provide the examiners with some feedback which may be considered in deciding your final marks.

Time can be very tight, as you only have 10 minutes including reading time. One way to use your time more effectively is to become familiar with the format of the information provided – you will see that half the text on the page is the same for all cases – once you know what this says, you can ignore it in the exam, reducing your reading time.

Practise makes perfect

The selection centre assesses skills, rather than just knowledge, so it is really important to try to get as much practise for each station as possible before the exam. Forming a study group to work through sample cases and practise together can be a useful way to improve. If you can get specific feedback on your communication and consultation skills this can help you work on making improvements.

Applying for GP Training

The process of applying to GP comprises the following stages:

Longlisting (formerly known as Stage 1) is based on the submission of your application via Oriel. To be longlisted, you need to meet the eligibilty criteria. The main ones are:

– Eligible for full registration with the GMC
– 2 years post graduation experience
– Evidence of Foundation Year 2 competences

Read the FULL eligibility critera in the National Person Specification from the National Recruitment Office site.

Multi Specialty Recruitment Assessment (formerly known as Stage 2) is a computer based exam comprising both clinical and professional dilemma multiple choice questions.

– Professional dilemma paper – 58 Situational Judgement Test questions in 110 minutes. These questions are in 2 formats – ranking SJTs and multiple selection SJTs – they test professional attributes, judgement and decision making.
– Clinical problem solving paper – 97 clinical questions in 75 minutes. These questions are in various formats and test broad clinical knowledge at the level of a doctor who has completed FY1. Subjects covered in this paper include

  • Cardiovascular
  • Dermatology / ENT / Eyes
  • Endocrinology / Metabolic
  • Gastroenterology / Nutrition
  • Infectious disease / Haematology / Immunology / Allergies / Genetics
  • Musculoskeletal
  • Paediatrics
  • Pharmacology / Therapeutics
  • Psychiatry / Neurology
  • Reproductive (male and female)
  • Renal / Urology
  • Respiratory

You can download the official SRA sample questions from the National Recruitment Office to get an idea of the type of question in each paper.

Candidates will be shortlisted to Stage 3 based on how they score in the SRA – the application, past experience, additional qualifications are not considered. If you score 575+ combined, you will be exempt the next stage and given a direct offer.

Selection Centre (formerly known as Stage 3) involves 3 simulated consultations (1 with a simulated patient, 1 with a relative or carer and 1 with a colleague) and a written prioritisation exercise (essay style question). You can download the official stage 3 sample cases / questions from the NRO to see examples of the type of thing to expect.

GPST Flow Chart

NRO Guidance for Applicants

There are three rounds of recruitment each year for GP training, dates as follows:

Round 1 – applications open in autumn/winter (November/December) for jobs starting the following August. The SRA is usually first week of January, with the Selection Centre taking place in the first 2 weeks of February.

Round 1 Re-advert – applications open in the spring (March/April) for jobs starting in August the same year. The SRA is usually late April with the Selection Centre in early May. This used to be known as Round 2.

Round 2 – applications open in August for jobs starting the following February. The SRA is in mid-September and the Selection Centre about 2 weeks later. This was previously known as Round 3.

Jobs that are unfilled from Round 1 are available in Round 1 Re-advert for both new applicants and those who applied in Round 1 but were unsuccessful. All jobs start in August.

The jobs available in Round 2 are jobs unfilled by the previous two rounds of recruitment – jobs start in February.

GPST Timeline

NRO Key Dates