The Professional Dilemmas paper is the half of the MSRA that candidates prepare for least and lose the most unnecessary marks on. It is not a knowledge test. It is a calibration test: how closely your judgement matches a published standard, under time pressure. That is something you can train in a month, at about half an hour a day. Here is a plan.
What you are preparing for
Fifty scenarios in 95 minutes, roughly half ranking items and half choose-three. Each scenario is pitched at the level of a Foundation doctor whatever specialty you are applying to, and each sits in one of three domains: professional integrity, coping with pressure, and empathy and sensitivity. The standard the key is written to is the GMC's Good Medical Practice (2024), not what a tired registrar would actually do at 3am.
The detail that changes everything is the marking. Ranking items are not right or wrong. Each option earns marks by how close you place it to its position in the key, so two neighbours swapped cost one mark each, and only an option four places adrift scores nothing. Choose-three items pay for each of your three picks that appears in the key. There is no negative marking in either format. If that is news to you, read how the paper is marked before anything else. The rest of this plan assumes you have.
Week 1: find out where you stand
Do not start by reading. Start by answering. Work through 30 or 40 scenarios untimed, in both formats, and read the explanation for every option, including the ones you got right. The point is not the score. The point is to notice the pattern in what you get wrong.
Most candidates discover one of three habits in the first week:
- Escalating too fast. Going straight to the consultant, the clinical director or the GMC when a conversation with the person involved was the proportionate first step. The key rewards the measured action, with escalation held in reserve.
- Escalating too slowly. Ranking "monitor the situation" or "raise it at the next meeting" in the middle when a patient is at risk now. Where there is live risk, inaction belongs at the bottom.
- Protecting a colleague over a patient. Covering for a struggling peer feels loyal. Good Medical Practice is clear that patient safety and honesty come first, and the key follows it.
By the end of the week you should be able to name your habit. Write it down. It is the thing the next three weeks are for.
The free ten scenarios on MSRA Practice are a reasonable first session: seven ranking, three choose-three, marked option by option, no account needed.
Week 2: learn the standard, then apply it
Now read. Not the whole of Good Medical Practice, which is long, but the parts that keep deciding items: honesty and candour, raising concerns, working within your competence, consent and confidentiality, and your own health and conduct. Our guide to Good Medical Practice for the MSRA maps the duties to the kinds of scenario that test them.
Then go back to practice, 15 to 20 scenarios a day, and before you commit to an answer ask one question: which duty is this item actually about? Most scenarios dress up a single principle in a clinical costume. Once you see the principle, the best and worst options usually declare themselves, and the ends of a ranking are where the marks live.
Keep a note of every item where you disagreed with the key after reading the explanation. Some of those are you being wrong. A few may be the item being arguable, and a good bank will let you say so. MSRA Practice has a feedback button on every item for exactly that reason, and the explanations are rewritten when a point is fair.
Week 3: technique by format
Ranking and choose-three reward different habits, and treating them the same costs marks on both. This is the week to separate them.
For ranking, place the best option and the worst option first. Those two positions can each lose four marks; the middle three can lose one each. If you are stuck on the order of the middle, pick a plausible sequence and move on. For choose-three, look for the three actions that would each be right on their own, and be suspicious of pairs: the paper likes to offer a good action alongside a slightly worse version of it, and the worse one is the distractor.
Work timed from now on. Two minutes for a ranking item, a minute and a half for choose-three, which is roughly how the 95 minutes divide across 50 items. It feels fast the first day and normal by the third.
Week 4: full papers, then rest
Sit two complete mocks under exam conditions: 50 items, 95 minutes, no pausing, finish every item even when unsure, because a guessed ranking scores well above zero and an unranked one scores nothing. Leave a day between them.
After each mock, ignore the headline score and read the review by domain and by principle. If one principle is costing you marks across several items, that is your last piece of revision. If the marks are scattered, you are calibrated and the remaining variance is noise.
Stop two days before the exam. The paper rewards clear, proportionate judgement, and that is the first thing to go when you are tired.
Where MSRA Practice fits
MSRA Practice was built around the plan above. The bank holds 200 original scenarios, 110 ranking and 90 choose-three, across all three domains, each marked by distance from the key the way the real paper is. Every option has an explanation that cites the Good Medical Practice duty it turns on. Timed mocks run at 50 items in 95 minutes with a question map, and the Review page breaks your results down by domain and by principle so week four's diagnosis takes minutes rather than an evening with a spreadsheet.
It costs £29.99, once, with access through the January 2027 sitting and the window after it. No subscription. If it is not what you expected, email within 14 days for a full refund.
Frequently asked questions
Is four weeks enough to prepare for the Professional Dilemmas paper?
For most candidates, yes, at about half an hour a day. The paper tests judgement against a published standard rather than recall, so the work is calibration: learning where your instincts and Good Medical Practice part company, then practising until they do not.
Should I spend more time on Clinical Problem Solving or Professional Dilemmas?
Both papers count. Clinical Problem Solving rewards knowledge you have spent years building, so revision there has a known shape. Professional Dilemmas is where candidates who have never looked at the marking lose marks they did not need to lose, and where a few weeks of the right practice moves a score furthest.
How many practice scenarios do I need?
Enough to see each domain and each format many times, and to sit at least two timed papers. A couple of hundred scenarios covers that. More is not better if you are not reading the explanations.
What if my score goes down between mocks?
One mock is a noisy measure. Look at the review by principle instead: if the same Good Medical Practice principle keeps costing marks, read it in the guidance and work through items that turn on it. Scores on a 50-item paper move by several points on their own.