MSRA · Professional Dilemmas

MSRA Professional Dilemmas: ranking, select-three and judgement

The PD paper is a Situational Judgement Test. It assesses how you believe an F2 doctor should behave in challenging professional situations rather than testing factual medical knowledge.

95 minutes50 scenariosAround half ranking and half multiple-choice/select-three

Ranking questions

Ranking items ask you to order 4 or 5 independent actions from most to least appropriate.

Judge each action on its own merits rather than imagining a chronological sequence.
Put patient safety and immediate risk ahead of convenience.
Prefer proportionate, professional actions over punitive or avoidant responses.

Select-three questions

Multiple-choice PD items ask for the three actions that, taken together, best resolve the situation.

Choose exactly three actions from a larger set of plausible options.
Look for a combination that addresses immediate safety, communication and appropriate follow-up.
Avoid selecting three near-duplicate actions that leave another important aspect unmanaged.

The three core domains

The official blueprint targets professional integrity, coping with pressure, and empathy and sensitivity.

Professional integrity includes honesty, responsibility, boundaries, risk and fairness.
Coping with pressure includes self-awareness, seeking help, resilience and managing uncertainty.
Empathy and sensitivity includes understanding patient and colleague perspectives without losing professional judgement.

Preparation

How to practise deliberately

Practise from the perspective of an F2 doctor rather than a consultant or manager.
Separate immediate patient-safety action from supportive follow-up and system learning.
For ranking questions, compare options pairwise when the middle order is difficult.
For select-three, check that your chosen combination addresses the whole problem.
Attempt every question because the official paper uses no negative marking.

Common mistakes

What to avoid

Choosing the most punitive action because the behaviour described is concerning.
Ignoring immediate safety while focusing on long-term support.
Assuming ranking options happen in sequence.
Treating empathy as agreement or avoiding necessary escalation.

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Official source

NHS England — Professional Dilemmas paper

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

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