The specialty recruitment assessment (formerly GP Stage 2 assessment) is an important part of the recruitment process for GP ST entry. This assessment determines if you will be shortlisted for the GP Stage 3 assessment (selection centre) – and if you perform very well (top 25-30%) then you can get a direct offer without having to attend selection centre. The assessment is also known as the SRA or Multi Specialty Recruitment Assessment – MSRA as it is used by various specialties as part of the ST1 / CT1 entry process. The assessment will be done entirely on computer, and consists of two parts lasting a total of 2 hours 55 minutes – a clinical problem solving section and a professional dilemma section. In this article, Dr Mahibur Rahman explains what to expect and how to prepare for this important assessment.

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

1. 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 http://www.emedica.co.uk/sra-answers.html

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

This is a 95 minute assessment with 50 situational judgement test questions (SJT) (in past years it was 110 minutes with 58 questions). 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 http://www.emedica.co.uk/sra-answers.html

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 some 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 (there are full timed mocks for both papers in the Emedica online revision package for the SRA). Finally if you would like to cover a lot of high yield topics in 1 day, and bost your exam technique for both papers to maximise your scores, the Emedica SRA Crammer course is for you:

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.