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MSRA · Clinical Problem Solving

MSRA Clinical Problem Solving: format, topics and how to practise

The CPS paper tests whether you can apply Foundation-level clinical knowledge to realistic decisions. It is not simply a recall paper: the official blueprint emphasises synthesis, investigation, diagnosis, emergency care, prescribing and management.

75 minutes86 itemsAround half SBA and half EMQ

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The CPS paper tests whether you can apply Foundation-level clinical knowledge to realistic decisions. It is not simply a recall paper: the official blueprint emphasises synthesis, investigation, diagnosis, emergency care, prescribing and management.

Single Best Answer questions

SBA items present one clinical scenario and ask for the single most appropriate or likely answer from a short list.

  • Expect 5 to 8 plausible options.
  • Choose the best answer for the information given rather than the most sophisticated possible answer.
  • Do not wait for information that the stem has deliberately not provided.

Extended Matching Questions

EMQs use one response set across several separate scenarios, so the same option can be used once, more than once or not at all.

  • Read the instruction before the scenarios so you know what decision is being tested.
  • Treat each scenario independently.
  • Use the common response list efficiently rather than re-reading it from scratch each time.

The 12 clinical areas

The official blueprint balances items across broad Foundation-level clinical areas rather than one specialty-specific syllabus.

  • Cardiovascular; Dermatology/ENT/Eyes; Endocrinology/Metabolic.
  • Gastroenterology/Nutrition; Infectious disease/Haematology/Immunology/Allergies/Genetics; Musculoskeletal.
  • Paediatrics; Pharmacology/Therapeutics; Psychiatry/Neurology; Renal/Urology; Reproductive; Respiratory.

Preparation

How to practise deliberately

  1. Practise deciding what the question is actually asking before looking at the options.
  2. Revise common FY2-level presentations through diagnosis, investigation and management rather than isolated facts.
  3. Use timed mixed-topic sets so switching between specialties becomes routine.
  4. Review every wrong answer by identifying the decision error, not just the missing fact.
  5. Use the official MSRA practice paper alongside commercial or independent resources.

Common mistakes

What to avoid

  • Overthinking beyond the Foundation-level scenario.
  • Choosing a technically possible answer rather than the single best next step.
  • Treating EMQ scenarios as linked when they are independent.
  • Revising facts without practising clinical decisions under time pressure.

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Official source

NHS England — Clinical Problem Solving paper

Last checked 24 September 2026. Official NHS England guidance remains the source of truth.

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