How does UK specialty training recruitment work?
Most entry to specialty training is run through national recruitment. In England this is coordinated by NHS England's Medical and Dental Recruitment and Selection team, with a lead recruiting office for each specialty, and applications go through the Oriel portal. Scotland, Wales and Northern Ireland take part in national recruitment for most specialties but also publish their own information.
- Check eligibility: Read the national person specification for your specialty and entry level, such as CT1, ST1 or ST3.
- Apply in the window: Each round has a fixed window and late applications are not accepted. Recent rounds have limited how many applications you can make, so choose carefully.
- Longlisting: Recruiters check essential criteria. If you do not meet one, you do not progress.
- Shortlisting: Depending on specialty, this uses your MSRA score, verified self-assessment, or both.
- Interview: Most interviews in England are online. A few specialties use the MSRA as the main selection tool in some rounds.
- Ranking and offers: Scores are combined into a rank, and offers are matched to your rank and programme preferences.
Who is eligible, and what does prioritisation mean for IMGs?
| Common question | What to check |
|---|---|
| Do I need full GMC registration? | For 2026 recruitment, full registration with a licence to practise was required at the time of application. Confirm the current rule in the applicant guide. |
| I did not do the UK Foundation Programme | You normally need an approved competence form signed by a supervising consultant within an accepted time frame. The person specification says which. |
| I have worked in the specialty already | Some core and run-through programmes cap previous experience. Count your months accurately. |
| Can I apply to several specialties? | Yes, within the round's limit. One MSRA sitting can serve several specialties in the same round. |
The Medical Training (Prioritisation) Act became law on 5 March 2026 and applies across the UK. Applicants are either in a priority group or not. According to the NHS England Medical Hub, the priority group includes graduates of UK or Irish medical schools (with some conditions), certain other listed countries, people with listed immigration statuses such as British citizenship or indefinite leave to remain, and those who have completed or are on a relevant UK programme such as the UK Foundation Programme.
Prioritisation does not change your interview score or rank. For 2027 recruitment it applies at the offer of interview and the offer of a training post, with some exceptions. Priority applicants are considered first; others are considered when posts remain. Partner or dependant visa status does not on its own place you in the priority group.
How does verified self-assessment work?
Many specialties use a self-assessment form. You choose the option that describes your achievements in domains such as extra degrees, presentations, publications, teaching, quality improvement, leadership and commitment to the specialty. Each option has a score. You upload evidence later, by a strict deadline, and assessors check every claim. If evidence does not support your choice, your score is reduced. Missing the evidence deadline usually means withdrawal.
| Claim | Weak evidence | Strong evidence |
|---|---|---|
| Led a QI project | A slide listing you among contributors | Consultant letter confirming you led it, plus a report showing two cycles |
| Teaching experience | Your own list of dates | Programme naming you as organiser, plus collated feedback |
| National oral presentation | The abstract alone | Conference programme showing you as presenter, or a certificate |
| Postgraduate degree | An enrolment letter | The degree certificate, translated if needed |
Anil collected data for a two-cycle audit that a registrar designed and presented. He selects 'I have led a complete QI project' because it scores more.
Anil selects 'I have participated in a QI project', uploads a consultant letter confirming his data collection role, and plans to lead his own project before next year's round.
What is the MSRA and how is it structured?
The Multi-Specialty Recruitment Assessment is a computer-based test used by several specialties, including General Practice, Core Psychiatry, Core Surgical Training, Anaesthetics, ACCS Emergency Medicine, Clinical Radiology, Obstetrics and Gynaecology and Ophthalmology, among others. The list can change, so check it each year.
| Paper | Questions and time | What it tests |
|---|---|---|
| Professional Dilemmas | 50 questions in 95 minutes | Judgement in workplace situations: ranking responses and choosing three actions |
| Clinical Problem Solving | 97 questions in 75 minutes | Clinical decisions across diagnosis, investigation, emergencies and prescribing: EMQs and single best answer |
These are the published formats at the time of writing; confirm them with the official practice paper before your sitting. There is no negative marking, so answer every question. There is no pass mark either: the MSRA ranks candidates, and each specialty decides how to use the score. Do not plan around rumoured cut-offs from previous years.
How should I prepare for the MSRA?
Professional Dilemmas is written from the view of a foundation-level doctor in the NHS. Strong answers usually put patient safety first, act within competence, deal with problems directly and in person where appropriate, and escalate proportionately. Many international graduates find this paper harder than expected because expected behaviour differs between systems. Reading Good Medical Practice and the GMC's guidance on raising concerns, consent and confidentiality is the best preparation.
- Sit the official practice paper under timed conditions to find your weaker paper and topics.
- Plan backwards from your sitting, spending most time on low-scoring areas.
- Base clinical answers on UK guidance such as NICE and the BNF, not guidelines from elsewhere.
- Practise timing: CPS allows under a minute per question.
- For each wrong answer, write one line on why the correct answer is right.
- Do a full timed mock in the final week.
What happens at a specialty training interview?
In England, specialty interviews are online. Expect rules such as being alone in a quiet room (you may be asked to show it), keeping camera and microphone on, showing photographic ID and not recording. Each panel member scores independently against a structured mark scheme that rewards safe, structured, reflective answers rather than long ones.
| Station | What the panel looks for |
|---|---|
| Portfolio or career | Commitment, insight into the role, reflection on achievements |
| Clinical scenario | Prioritisation, ABCDE where relevant, escalation and communication |
| Professional or ethical | Patient safety, honesty, working within competence, GMC guidance |
| QI or leadership | Understanding of method, measurement and sustainability |
I have always been passionate about psychiatry. I find the brain fascinating, I enjoyed my rotation and I am hard-working and empathetic.
On a liaison psychiatry team I assessed a young man after an overdose who had been labelled attention seeking. A full history revealed untreated psychosis, which showed me how much the specialty depends on careful assessment. Since then I have completed a two-cycle audit of risk assessment documentation in the emergency department, presented it at the trust audit meeting, and set up monthly mental state examination teaching for foundation doctors.
A worked example: planning an application as an IMG
Sana qualified overseas, has full GMC registration and 18 months in a UK non-training post. She plans to apply to core psychiatry and general practice. She has collected data for one audit, taught medical students at the bedside and presented a poster at home. She has no formal leadership role.
She downloads both person specifications and asks her consultant early to complete the competence form within the accepted time frame. Both specialties use the MSRA, so she sits the practice paper, finds Professional Dilemmas harder, and focuses on GMC guidance. She chooses the participation option for her audit, asks to help organise the next foundation teaching programme with written confirmation of her role, and files evidence by domain. She checks the prioritisation rules herself and notes the review deadlines, without assuming an outcome.
Offers, preferences and next steps
Only rank programmes you would genuinely accept, and read the rules on holding, accepting, declining and upgrading offers, including deadlines. If you are unsuccessful, request your scores and any feedback, check later rounds, and use the year to close specific gaps such as completing a QI project you lead or gaining a teaching qualification. Unsuccessful applications are common in competitive specialties and are not a judgement of your worth as a doctor.
Our course Specialty Training Applications covers eligibility, honest self-assessment, MSRA preparation and interview stations in more depth, with a reflective planning exercise. NHS Job Applications and Supporting Statements and NHS Interview Skills may help with non-training posts while you build experience. No course can promise a training post.
Frequently asked questions
What is a good MSRA score?
There is no pass mark. The MSRA ranks candidates against each other, and each specialty decides how to use the score, for example as a shortlisting threshold or combined with an interview score. A score that is competitive in one specialty or year may not be in another. Check what your specialty publishes and avoid planning around rumoured cut-offs.
How long is the MSRA exam?
Published information describes two papers on the same day: Professional Dilemmas, with 50 questions in 95 minutes, and Clinical Problem Solving, with 97 questions in 75 minutes, with an optional short break between them. There is no negative marking. Confirm the current format in the official guidance and practice paper before your sitting.
Can IMGs still get specialty training after the prioritisation law?
Yes, IMGs can still apply. Prioritisation means applicants in the priority group are considered first at set stages, such as interview offers and post offers. Applicants outside it may still be offered interviews and posts when vacancies remain, depending on specialty competition. Some IMGs are in the priority group, for example through immigration status or a relevant UK programme.
Who is in the priority group for specialty training?
According to the NHS England Medical Hub, it includes graduates of UK or Irish medical schools (with conditions), graduates from certain listed countries, people with listed statuses such as British citizenship or indefinite leave to remain, and those who have completed or are on a relevant UK programme such as the UK Foundation Programme. Check the current rules, as further categories apply from 2027.
What happens if I overclaim on my self-assessment?
Assessors check every claim against your uploaded evidence. If it does not support your chosen option, your score is reduced. A large difference between claimed and verified scores can trigger a probity review, removal from recruitment and, in serious cases, referral to your employer or the GMC. Always choose the option your evidence clearly supports.
Do I need the UK Foundation Programme to apply for core training?
No, but you must show foundation competence. Applicants who have not completed the UK Foundation Programme usually need an approved form signed by a consultant who has supervised them, within a time frame set in the person specification. Note that for prioritisation at CT1 and ST1, the UK Foundation Programme is the relevant UK programme.
How do I prepare for a specialty training interview?
Read the person specification and mark scheme guidance for your specialty, then prepare specific examples for portfolio and QI questions using STAR with reflection. Practise clinical scenarios aloud using ABCDE and escalation, and ethical scenarios based on GMC guidance. Do timed online mock interviews and check the technical and room rules for your specialty in advance.
Related courses
Specialty Training Applications
This course explains how UK medical specialty training recruitment works, from eligibility and the person specification through verified…
NHS Job Applications and Supporting Statements
This course teaches you how NHS applications are shortlisted and how to write an application and supporting statement that clearly matches the person…
NHS Interview Skills
This course prepares you for NHS interviews by explaining how panels assess candidates and how to give structured, evidence-based answers. It covers…
Sources and further reading
- Prioritisation for specialty recruitment. NHS England Medical Hub.
- What the new law means for UK graduate prioritisation. British Medical Association.
- Multi-Specialty Recruitment Assessment (MSRA): overview and official practice paper. NHS England Medical Hub.
- Medical specialty recruitment applicant guidance and person specifications. NHS England Medical and Dental Recruitment and Selection.
- Good Medical Practice (2024). General Medical Council.
- Raising and acting on concerns about patient safety. General Medical Council.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
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