Ranking versus choose three

Last updated 12 October 2026

The Professional Dilemmas paper mixes two formats. They test the same judgement but reward different habits, and candidates who treat them the same way lose marks on both.

Ranking: five options, one order

You are given four or five actions and asked to put them in order from most to least appropriate. Each option is marked by how close your placement is to the key's, so the item carries a separate score for every option: up to 20 marks for five options, 16 for four. See how the paper is marked for the arithmetic; the short version is that the first and last positions carry the most risk and the middle three carry the least.

How to approach it

1. Read the scenario for the one fact that decides the item. Usually it is whether anyone is at risk now, and who you are in the scenario (your grade, your relationship to the people involved).
2. Pick the best and the worst. The best is usually the most direct action that deals with the problem now, honestly and in proportion. The worst is usually the one that ignores, conceals or delays.
3. Order the middle three by proportion. Ask what the next step would be if the best option did not work. Over-escalation (going to the top when a conversation would do) typically sits below a measured step but above doing nothing.
4. Do not re-read the options looking for traps. The paper is not written to trick you. If two options seem equally good, the difference is usually that one acts sooner or involves the right person.

Common errors

• Ranking an option low because it is not a complete solution. Options are judged as actions in context, not as plans.
• Ranking "do nothing" or "wait and see" in the middle because it seems harmless. Where a risk exists, inaction usually belongs at the bottom.
• Placing escalation to a very senior person first. Unless the risk is immediate or the person involved is the problem, a proportionate first step ranks higher.

Choose three: eight options, three picks

You are given eight actions and asked to choose the three most appropriate. The three are unordered, and each pick that is in the key earns marks. Five of the eight are distractors, often designed in pairs: a good action and a slightly worse version of it, or an appropriate action attached to an inappropriate one.

How to approach it

1. Judge each option on its own. The three do not need to form a coherent plan. Ask of each: is this, by itself, something a good Foundation doctor would do here?
2. Eliminate the clearly inappropriate first. There are usually two or three options that are plainly wrong (dishonest, unsafe, outside your competence). Removing them leaves five or six to choose three from.
3. Look for the pairs. Where two options describe similar actions, one is usually there to be rejected. Prefer the one that acts sooner, involves the right person or is more honest.
4. Pick exactly three. You cannot pick four. If you have four candidates, drop the one that is least about the patient and most about you.

Common errors

• Choosing a "complete" set (one action for the patient, one for the colleague, one for the record) instead of the three most appropriate actions. The key does not reward coverage.
• Picking an option because it is reasonable, when a better version of the same action is also listed.
• Running out of time and picking two. Two correct picks score eight of twelve; three guesses with one hit score four. Always pick three.

Timing

With about 50 items in 95 minutes you have under two minutes an item. Ranking items need a little more thought than choose-three, so plan on about two minutes for ranking and a minute and a half for choose-three. In MSRA Practice mocks the clock runs for 95 minutes and the question map shows which items you have answered and flagged, so you can see the trade-off as you make it. An item left unanswered scores zero on every option; an item answered quickly scores something.

Sources

• Health Education England and Work Psychology Group, MSRA Professional Dilemmas candidate guidance (formats, timing, marking structure).
• General Medical Council, Good medical practice (2024). See Good Medical Practice for the MSRA.

Frequently asked questions