Clinical Problem Solving paper

What's in the MSRA?

The Clinical Problem Solving (CPS) paper is an assessment which measures your ability to apply clinical knowledge in and make clinical decisions in everyday practice.

Aims of the Clinical Problem Solving paper

The Clinical Problem Solving (CPS) paper is an assessment which measures your ability to apply clinical knowledge in and make clinical decisions in everyday practice. 

The scenarios are based on Foundation-level clinical practice. They test your ability to synthesise and apply medical knowledge (not just your recall of knowledge).

Context and setting

CPS items are based in 12 clinical topic areas relevant to general medicine. Each test paper includes a balance of scenarios which cover all 12 topics. The topics covered include:

  • Cardiovascular 
  • Dermatology / ENT / Eyes
  • Endocrinology / Metabolic
  • Gastroenterology / Nutrition
  • Infectious disease / Haematology / Immunology / Allergies / Genetics
  • Musculoskeletal 
  • Paediatrics 
  • Pharmacology and therapeutics
  • Psychiatry / Neurology 
  • Renal / Urology 
  • Reproductive 
  • Respiratory

Scenarios are all relevant to the Foundation (FY2) training programme. Where a setting is specified in the question, this has only been chosen to provide a context; but the judgement required to answer the question is not specific to that setting.

Target domains

The test covers 5 core domains / competencies.

  • Investigation: Specific investigations that are carried out in order to obtain a more conclusive diagnosis, or rule out possible causes of illness/injury.
  • Diagnosis: Identification of a condition, disease or injury made by evaluating the symptoms and signs presented by a patient.
  • Emergency: Potential serious illness requiring an immediate response (recognising patient risk based on suggested factors).
  • Prescribing: Advising, authorising or reviewing the use of medicine/drugs as part of a patient's clinical management plan.
  • Management (non-prescribing): Advising, authorising or reviewing the use of other forms/methods of treatment (not medicinal/drug-related) as part of a patient's clinical management plan.

Item types and formats

There are 86 items in the CPS paper. Around half of the items are Extended Matching Questions (EMQ) and the other half are Single Best Answers (SBA).

Extended Matching Question (EMQ)

EMQs refer to multiple clinical scenarios that are linked to the same set of response options.

You will be presented with a list of 7 to 10 plausible response options and multiple, separate questions linked to this response set. You need to select the most appropriate or likely answer for each clinical presentation, for example, "For each patient, please select the most appropriate drug to prescribe."

Each response option can be selected once, more than once or not at all when responding to the set of cases.

Example

Tremor and tingling

  • a. Acromegaly
  • b. Diabetes
  • c. Hyperthroidism
  • d. Hypothyroidism
  • e. Hypoadrenalism
  • f. Hypoparathyroidism
  • g. Hypopituitarism

For each patient, what is the single most likely diagnosis?

Select 1 option only from the list above. Each option may be selected once, more than once, or not at all.

  1. A 58-year-old woman develops a tremor, and has repeated episodes of breathlessness associated with tachycardia.
  2. A 44-year-old woman develops tingling in her fingers 3 days after a total thyroidectomy for papillary carcinoma of the thyroid.
Single Best Answer (SBA)

You will be asked to select the single most appropriate or likely answer out of 5 to 8 plausible responses for 1 clinical presentation, for example, "Select the single most appropriate diagnosis from the list below."

Example

A 17-year-old student suddenly develops chest pain and dyspnoea after a morning swim. His trachea is deviated to the left. There is hyper-resonance and decreased breath sounds on that side.

Select the single most likely diagnosis from the list below. Select 1 option only.

  • a. Asthma
  • b. Left ventricular failure
  • c. Pneumothorax
  • d. Pulmonary Embolus
  • e. Pulmonary haemorrhage

Item development

A well-established team of trained item writers, who are also clinicians, have responsibility for developing new items year on year. Some of these are then piloted alongside the operational tests. This is the same team that produces the PD items.

All new CPS items undergo a thorough review process that includes a review by a nominated clinician, and further review and refinement by the team of SME item writers. At each stage, items are reviewed for fairness and relevance. Reviews also take place to ensure that each item is appropriate for all candidates in terms of language used (items undergo an English Not First Language review) and that locality-specific knowledge is not tested. This ensures that the CPS is fair to all candidates.

Once items are piloted, they are reviewed again by a statistician to establish their psychometric performance, and undergo a further review from the SMEs. Consideration is given to:

  • how the best performing candidates answered the items
  • how candidates responded to each of the distractors (such as incorrect response options)
  • the item’s correlation with live test performance
  • the item’s level of difficulty and ability to differentiate candidates’ performance
  • whether it appears to be favouring any particular demographic groups (such as differential item functioning)

Following satisfactory performance, successful CPS items can enter the operational item bank.

Scoring process

For each item, 1 mark is awarded for choosing the correct response. There is no negative marking.

Related information

Page last reviewed: 29 May 2024
Next review due: 29 May 2025