What the Clinical Problem Solving paper tests
The Clinical Problem Solving (CPS) paper measures your ability to apply clinical knowledge and make clinical decisions in everyday practice. It has 86 items in 75 minutes, across 12 clinical topic areas and 5 domains, at Foundation level.
What it is for
The facts on this page come from the official Clinical Problem Solving and structure pages. The Clinical Problem Solving page describes the paper as an assessment of your ability to apply clinical knowledge and make clinical decisions in everyday practice. The scenarios are based on Foundation-level clinical practice, and they test whether you can synthesise and apply medical knowledge, not just recall it.
All scenarios are relevant to the Foundation (FY2) training programme. Where a question names a setting, the official page says the setting is there only to give context: the judgement needed to answer is not specific to that setting.
The 12 topic areas
Items are based in 12 clinical topic areas relevant to general medicine, and each paper includes a balance of scenarios covering all of them.
| Number | Topic area |
|---|---|
| 1 | Cardiovascular |
| 2 | Dermatology / ENT / Eyes |
| 3 | Endocrinology / Metabolic |
| 4 | Gastroenterology / Nutrition |
| 5 | Infectious disease / Haematology / Immunology / Allergies / Genetics |
| 6 | Musculoskeletal |
| 7 | Paediatrics |
| 8 | Pharmacology and therapeutics |
| 9 | Psychiatry / Neurology |
| 10 | Renal / Urology |
| 11 | Reproductive |
| 12 | Respiratory |
The 5 domains
Across those topics, the paper covers five core domains. In the official page's terms:
- Investigation: the specific investigations carried out to reach a more conclusive diagnosis or to rule out possible causes.
- Diagnosis: identifying a condition, disease or injury by evaluating the symptoms and signs a patient presents with.
- Emergency: potential serious illness that needs an immediate response, including recognising risk.
- Prescribing: advising on, authorising or reviewing the use of medicines as part of a management plan.
- Management (non-prescribing): advising on, authorising or reviewing other forms of treatment as part of a management plan.
The two question types
There are 86 items. Around half are extended matching questions and the other half are single best answer questions.
- Extended matching question (EMQ). Several separate clinical scenarios share one list of 7 to 10 plausible options. For each scenario you choose the most appropriate or likely answer. An option can be used once, more than once or not at all.
- Single best answer (SBA). One clinical presentation, and you choose the single most appropriate or likely answer from 5 to 8 plausible responses.
The official page gives a worked example of each type. We do not reproduce them here; read them at the source.
How it is marked
One mark is awarded for each correct response. There is no negative marking, so an unanswered item gains nothing and a guess costs nothing.
How the questions are made
According to the official page, items are written by a team of trained item writers who are also clinicians, reviewed for fairness and relevance, checked so that locality-specific knowledge is not tested, and piloted alongside the live assessment before they enter the operational bank. The structure page adds that none of the question writers take part in or endorse any preparation courses or books. That includes ours.
A separate paper we do not cover yet
The MSRA's other paper, Professional Dilemmas, is a situational judgement test. It is a separate paper with its own format, and MSRA Navigator does not cover it yet. See MSRA format, timing and scoring for how the two fit together.
Dates and rules can change, and this page is not legal or careers advice. Confirm them on the official page before you rely on them: Clinical Problem Solving paper (NHS England).