Getting into specialty training has become increasingly competitive in recent years, so doctors need much higher scores in the MSRA to get a job offer, especially in popular areas. In this article, Dr Saloni Makhija shares how she scored 625 to rank 24th out of over 11,000 ranked candidates to get her first choice area in London deanery.

During my F3 year I began revising for the MSRA whilst locuming and also planning for my upcoming wedding, which proved to be quite stressful!

During medical school, I was very undecided about what specialty I wanted to choose, and I changed my mind every placement I completed. I therefore picked my F1 and F2 job line such that it would give me a good mix of different jobs to see what I liked the most. I was still undecided after the application window opened in F2, and was torn between GP and IMT. I decided not to apply for anything and take an F3 to locum and give myself more time to decide my plan. I completed a GP job at the end of F2 and really enjoyed it, solidifying my decision to choose GP. Moreover, most of the GP trainees I spoke to were very happy with their choice and thoroughly recommended the training programme.

I felt very lost initially when revising, having not taken an exam since medical school, and I was unsure about what I should actually be doing.  Furthermore, due to my work and personal schedule I was finding it very difficult to find the time to revise. It was a completely different experience for me compared to revising for my medical school exams, where I used to have at least a few weeks completely off every year just before the exam. For the MSRA, I found that I was having to fit my revision around my hectic daily schedule.

By October, I realized that I really needed to get my act together and create a revision timetable, ensuring that I set aside enough time to revise every day whether that be in the evenings or during my breaks. I was overwhelmed by the vast amount of content to cover for the clinical paper which essentially included all specialties, many of which I hadn’t covered since medical school.

I made a list of all topics and tried to set aside time for each topic based on how confident I felt in it. For example, one of my F2 jobs and most of my locum shifts were in geriatrics which I felt quite confident with, so I set aside less time for this, whereas I set aside a lot more time for obstetrics and gynaecology which I haven’t revised since medical school.

Soon after I started revising, I found that I was not going to have the time to go through my copious medical school notes for every topic. I decided that a much more efficient method of revising was to do question banks and make a note of the topics I was getting wrong. I then read further on these specific topics to consolidate my learning.

Prior to starting revision, I had asked some of my senior peers which question banks worked best for them. I got very varied responses with people suggesting all different question banks including Passmedicine, Emedica, MCQbank, Pastest etc. and I understand that there are a vast variety out there. However, I decided to stick with question banks that I had used previously and that I trusted so I used Passmedicine and Emedica. I did not want to get overwhelmed with too many question banks so I decided to thoroughly do just these.

I found that Passmedicine was good to cover the breadth of topics for the MSRA and had a very good, concise high-yield textbook which was great for a brief refresher of each topic after I’d done each question. I cross referenced every topic I’d covered with NICE CKS just to ensure the information was up to date with current guidelines. I completed all the Passmedicine questions and then moved on to the Emedica question bank.

The Emedica MSRA bank has three mini tests of 30 questions each per topic mapped to the MSRA blueprint. I did not do all the tests for each topic at once, but instead did one test from each topic and then moved on to the next topic. After I’d completed the first test from each topic, I went on to the second and then the third. This was to ensure that I did not forget the topics I had done at the beginning by the time I got to the end. I found the Emedica questions challenging but very useful and each question had a detailed explanation in the mark scheme.

I tried to spend at least an hour a day revising from October onwards, but around 4-5 hours on my free days. I tried to be strict about ensuring I found the time to do questions every day. Even when I didn’t have a dedicated evening to give to revision, I tried to find time whenever I could such as when I was on the tube to work or sat in the office waiting to attend a meeting with my wedding decorator!

During my revision, I quickly realized that my weakest area was the SJT paper. It is worth 50% of the total mark so something that should be given as much importance in revision as the clinical paper. I found revising for the SJT more difficult as it requires more knowledge of exam technique rather than content. I found the Emedica MSRA questions particularly useful for the SJT because of the clear explanations provided in the mark schemes.

I also attended the Emedica MSRA 2 day Crammer Course which I found invaluable in my revision. In just two days, you get to do timed teaching mock exams, one clinical and one SJT, with comprehensive mark schemes and detailed explanations. This was great to not only learn key content and recent guidelines, but also figure out timings which is very important in both papers. The SJT day was particularly useful as you get taught the GMC guidance on common topics such as confidentiality, consent and so on.

When the booking window opened, I ensured to book early at my desired location at my desired date. The day before the exam I double checked exactly where I needed to go to avoid any stress on exam day.  I made sure to get an early night to ensure I was well rested. On exam day I attended the venue early and started my test. I was amazed to see how similar the questions were to the ones I had done on the Emedica question bank as the stems were much shorter than on other question banks.

I utilized the timing guide that I had learnt on the Emedica course and things were going well until my computer crashed towards the end of the clinical paper when I still had 20 questions left. It took a while for the invigilator to attend to me and restart my computer which was extremely stressful! Fortunately, he was able to restart it a few minutes later and although I lost a little bit of time, I still managed to finish the paper thanks to my strict timekeeping. When I got my score of 625 (SJT 309, Clinical 316), ranking 24^th of over 11,000 GP applicants, I was delighted. I got my first choice London GP job which is what I was aiming for as I wanted to be close to home and I could not be happier.

Exam top tips

1. Organisation is key – make a revision timetable. The hardest part about the clinical paper is the vast amount of content you need to learn. Start early, give yourself as much time as possible (I gave myself about 4 months) before the exam and write down all the topics you need to revise. Make sure you get enough time to cover each specialty but do also give yourself dedicated SJT time as well.
2. Use NICE CKS to consolidate your learning – I’m someone that has always been a big note taker but I found that there just wasn’t enough time to make notes as such for the MSRA. Instead, I got out my old medical school notes to revise topics I was weaker on and made sure I cross referenced these with NICE CKS to ensure my knowledge was up to date.
3. Write down questions you get wrong – whilst I didn’t make new revision notes for the MSRA, I did make a note of all the questions I was getting wrong during my revision to identify weaknesses and gaps in my knowledge. In the couple of weeks just before the exam, I went through a list of all my incorrect questions to ensure I was covering topics I was weaker at.
4. Don’t neglect the SJT – This is 50% of the final score so it is equally as important as the clinical paper. I would strongly recommend reading the GMC Good Medical Practice prior to sitting the exam. I would also say, do not use multiple question banks for the SJT. I would focus on the official UKFPO SJT papers and the MSRA mock and make sure you really understand the mark scheme. I would then supplement this by doing questions from Emedica as they were the most representative of the real exam. Adding in multiple question banks can be confusing as the answers are sometimes conflicting with the official mark scheme as this is more of a subjective exam. I found revising for SJT was a good break from doing endless clinical questions and I tried to do at least a few questions every other day.
5. Find a study buddy – If you work well with others, I would recommend getting a revision buddy or study group to discuss SJT questions. I felt this made revision more fun and it was useful to discuss questions that I had got wrong with other people as they were able to give a different perspective and help me understand where I went wrong with respect to the mark scheme.
6. Timing is crucial –  in the last week of revision I would definitely recommend doing the timed mocks on Emedica. My exam experience was quite stressful but because I had stuck to time, I was able to complete the paper. If you are taking too long on a question, pick an answer and flag it (as there is no negative marking, you can come back to it at the end if you get time). There is no point spending extra time on a question that is worth one mark if it means that you will miss out on multiple subsequent questions.
7. Be confident in yourself –  I came out of my exam feeling I had not done well, especially with my  technical difficulties, but ended up with a good score. If you put the hard work in it will pay off.

Best of luck to you all!