The MSRA is an important part of the assessment process for entry into specialty training at ST1 / CT1 level for many different specialties. In this article Dr Georgina Ormerod shares here experience of how she managed to get one of the highest scores in the country while juggling studying with work and young children, and her tips on how to prepare effectively.

I finished my Foundation Training just in time for Christmas after a bumpy ride with multiple high risk pregnancies and was planning to enjoy some time with my family and finally have the thinking space to work out what sort of career I would have within medicine – preferably somewhere within the field of child health. Then came the pandemic, months of home-schooling and job uncertainty and so I put in a fairly last-minute round 2 application for psychiatry (with my eyes on one of the elusive run-through CAMHS posts) and GP. I then realised I would also need to revise for the MSRA having not sat an exam since finals and that there would be no face-to-face interviews! I felt very under pressure to do well as I also needed to stay in London for family reasons including childcare and schools.

I had naively assumed that my medical school strategy of doing my best at learning everything would continue to serve me well for the MSRA and maybe it would had I had more time, however once I had dug out folder after folder and a giant pile of textbooks not only did I feel completely overwhelmed but it was also clear that there was no way I could work through such a volume with less than two months and three small children to look after! A new strategy was needed urgently and I searched the internet and read review after review of the MSRA online question banks!

I had never used these before however in retrospect I am so glad I did despite the cost. I decided to use a variety of them and chose to do those which reviewers felt had a lot of background information first, making notes for every subject as I went through the questions the first time. Having worked my way through I would re-read all my notes and then attempt the questions again. I would repeat the questions until I was scoring high 85-90+% (usually on the second – or third for my weaker areas – attempt). Then I tried a further question bank and on the first attempt through the questions would add to my notes in the relevant section. I found all the question banks were broadly similar and each allowed me to add valuable points to my revision notes, which I would then re-read.

The very focused way of studying made it possible for me to feel like I was making progress and gain some confidence which was definitely needed and also to study in the little time I had available. Anyone with other commitments, especially small children will know how hard it is to study (at all or to combine this with feeling like a good enough parent) and I found keeping to a set structure the best way to do this over the summer holidays: My mum to whom I am eternally grateful, would look after the children after lunchtime for an hour or a little longer on a good day and I would furiously work my way through another section. If I had the energy in the evenings once the children were asleep I would do a further hour. I found it crucial to have my revision mapped out for the next few days ahead of time so that I could just sit down and work rather than waste time “planning”.

I found that I soon gained the confidence and knowledge doing the clinical questions but found the professional dilemma section much harder. I would do sections on the different question banks and score wildly differently every time. Being quite a scientific and methodical person this really worried me as I couldn’t really see an obvious reason for this as I was steadily practising and reading the question feedback and I started to panic, especially as everything was riding on the MSRA in this round due to Covid-19 restrictions. In the end I decided to do the Emedica SJT preparation course and am sure this is the reason I managed to “crack” the professional dilemma section! For me having the online recordings of the course was perfect as I could work my way through it in the last week before the exam in the evenings when the children were asleep. Being provided with a strategy with which to approach the question and listening to someone reasoning their way through the questions rather than reading the feedback proved invaluable and I finally felt as though I wasn’t blindly answering and second-guessing the question-writer’s intention and over-complicating matters. The other crucial part of information which I only really fully understood thanks to doing the course was the importance of timing. Although for many the timing problem arises from not being able to get through the volume of text, I read very quickly and had been racing through the questions in double-quick time terrified of not finishing. The practical experience of the course finally made me slow down, re-read and mentally highlight key parts of the question and answers which I think made a big difference.

In the last few days before the exam I found the extensive mocks on the Emedica website the most useful as they contained unknown questions so felt “more real”. I also think their format was probably the closest to the exam so that the exam felt more familiar which was helpful, too. The last day I spent largely re-reading all my notes! I felt I could do acceptably in the clinical section but continued to really worry about the SJT component.

I had been allowed to take an online sitting for health reasons and so proceeded to sit the most unusual exam I have ever sat! The clinical questions are obviously fairly rapid fire so it felt hard to tell how they were going. The professional dilemmas all felt more vague compared to a lot of my practise but at least I felt I had a way of approaching them. Then, to make matters worse, the postman spent 15 minutes banging on my door and window and jumping up and down to get my attention which almost completely threw me and so I finished the exam convinced I had failed!

I spent the time period awaiting the results shadowing in two CAMHS units to help me make my decision (although given the exam I wasn’t expecting to be starting work before next August) and fortuitously found “my niche” in medicine which only made me more worried about my exam results. The CAMHS posts available then also got cut down from 6 to only 1.

The results were first published for the psychiatry applications and unbelievably I had scored 315 in the clinical part and 303 in the professional dilemmas section (I did log in a few times to check the scores were still there), ranking second in psychiatry and fifth in GP and was offered both the only CAMHS run-through post available, which I accepted and a London-based GP training post which I hope someone else will enjoy!

Having gone through the process feeling under a lot of pressure for a few reasons, I think my advice to those preparing for the exam, especially those with children and slightly more difficult revision circumstances would be:

1. Organisation and Routine: If you can, generate a daily study period that is as fixed as possible and plan ahead so you can just sit down and work your socks off for that hour or so. You will feel like you are making progress and you can enjoy the children the rest of the time!
2. Focus: Work out what it is you need to do and do only that! For me this was using a number of different question banks, generating my own notes from the ones with more detailed answers and then practising, practising, practising!
3. Strategy: Learn how to approach the professional dilemmas questions – this was a real game-changer for me
4. Timing: Practise practise practise how to have time on your side, especially for the professional dilemmas: whether that is slowing down and re-reading as it was for me or practising on getting your reading speed up!
5. Online sittings: Follow the guidelines and ban all other household members (especially toddlers and pets!!) from the house for the duration AND stick a big note on your door to stop any unwanted interruptions – this nearly cost me the exam!

Good Luck!

Dr Ormerod managed to get offers for both her 1st choice GP rotation and her 1st choice CAMHS rotation in London. She has accepted her CAMHS offer. The Emedica SJT preparation course she mentioned is Day 2 of the Emedica 2 day MSRA Crammer course (day 1 covers the clinical paper). The 2 day course also includes access to 2200+ online revision questions with full mock exams for both papers.