The following article was written by Dr Natasha Thandrayen MBBS (Lond), BSc (Hons), GPST1, who sat the GPST entry examinations in 2008 and gained her first-choice hospital and rotation at the London Deanery.
Tips on General Practice Specialty Training (GPST) Entry
Application Calendar (2009 Entry — Historical Reference)
The following calendar is reproduced for historical context and illustrates the typical structure of the GPST application cycle. Actual dates change annually; always check the National Recruitment Office website for the current cycle.
- Stage 1 — Applications submitted: 5th–18th January 2009
- Stage 2 exam — 21st February 2009
- Stage 3 exam — 23rd March–3rd April 2009
- Offer of training programme — by 24th April 2009
- Acceptance of training programme — by 1st May 2009
- Clearing — from 11th May 2009
Stage 1: Online Application
Stage 1 requires you to submit basic details such as GMC registration number, driving licence information, and evidence of foundation competencies. The only way to stand out at this stage is if you hold an additional qualification — for example, the Diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH). However, Stage 1 is primarily a registration and eligibility check rather than a competitive ranking stage.
Stage 2: Clinical Problem Solving Paper (95 Minutes)
The Clinical Problem Solving (CPS) paper tests your clinical knowledge across the full breadth of medical specialties. The question format can include:
- Single Best Answer (SBA) questions
- Extended Matching Questions (EMQs)
- Multiple Choice Questions (MCQs)
Questions are set at the level of clinical knowledge that an FY2 doctor would be expected to have. They are presented as clinical scenarios testing your ability to reach a diagnosis, select appropriate investigations, and choose correct management.
Do not underestimate this paper. It requires substantial preparation because of the broad range of topics across all specialties. It is not possible to cover each specialty in the same depth as medical school finals, but you need to be competent across all of them.
How to Revise for Stage 2
Everyone has a different revision style, and most candidates have developed their preferred approach by the time they sit postgraduate exams. A practical strategy is:
- If you made good notes during medical school finals, revisit them as a starting point.
- Do as many practice questions as possible — identify your weak areas and target those specifically.
- Use clinical scenarios to practise diagnosis, investigation, and management decision-making.
- Practise under timed conditions. Several candidates have failed Stage 2 simply by running out of time, not by lacking knowledge.
- There is no negative marking — attempt every question, even if you are unsure.
Professional Dilemmas Paper (115 Minutes)
The Professional Dilemmas paper (equivalent to the Situational Judgement Test, or SJT, in the current format) assesses your professional values and decision-making in difficult workplace situations.
These questions are deceptively tricky. There is usually an obvious best and worst answer, but the intermediate options are often very similar to one another. Familiarity with the examiners' priorities — professional behaviour, patient safety, honesty, seeking help appropriately — is essential. The only effective preparation is to do a large volume of practice questions and understand the rationale behind each answer.
Recommended Resources for Stage 2 and Professional Dilemmas
- ISC Medical: Excellent books containing MCQs, EMQs, and SJTs with detailed explanations of why each answer is correct or incorrect.
- Pastest: Questions closely resemble those in the real exam, with concise answer explanations. Check for the most current edition.
- Onexamination.com: A high-quality online question bank. The questions tend to be harder than the real exam — if you perform well here, you are in a strong position. Note that the SJT coverage may be more limited.
- Emedica: Particularly useful for situational judgement questions.
- gpexams.com: Contains a large number of SJT-style questions.
- Medical finals MCQ/EMQ books: Do not overlook these — they cover the specialty knowledge base that Stage 2 also tests.
Stage 3: Group Assessment and Individual Stations
Stage 3 typically includes a group exercise and, depending on the deanery and year, may include individual role-play or prioritisation stations. The exact format varies — check the current specification for your deanery.
The Group Exercise
Group work cannot be adequately prepared for alone, using books. The most effective preparation is to revise in small, trusted groups where honest, constructive feedback is given and received.
Some candidates who did not pass Stage 3 had revised exclusively on their own. While books give useful insight into the types of scenarios used, they cannot replicate the interpersonal dynamics of the real assessment. The key advantages of group revision are:
- You can observe how others interact and adapt your own style accordingly.
- You build confidence through repetition in a safe environment.
- You receive specific, honest feedback that can help you correct habits you are unaware of.
Revise with people who will give you honest feedback. Large courses are useful for the experience of working with strangers (as you will be in the real exam), but the feedback at such events is often too polite to be maximally useful.
When practising, rotate roles — take turns being the doctor, the patient, and the observer. The observer should score performance on specific criteria, and does not need to be a doctor. Involving non-medics can actually provide a valuable lay perspective on communication style.
Booking a Stage 3 Course
It is strongly recommended that you book onto a Stage 3 revision course. Weekend courses in particular offer the experience of working with unfamiliar candidates in a structured setting, which closely mirrors the real exam environment. Dr Thandrayen attended the Pastest evening course and found it informative, with useful tips — though it did not include group practice.
General Advice
Start your preparation early. The breadth of Stage 2 in particular rewards candidates who begin revision weeks in advance rather than cramming in the final days. Prepare methodically, practise consistently, and seek feedback actively at Stage 3.
Good luck!
Frequently Asked Questions
Has the GPST application process changed since this guide was written?
Yes, significantly. The GPST application process is managed nationally and has been updated multiple times since 2008. The key assessments now include the Situational Judgement Test (SJT) and Clinical Problem Solving (CPS) test, which together make up Stage 2. Stage 3 varies by deanery. Always refer to the National Recruitment Office for General Practice for the current application cycle and format.
What does the current GPST Stage 2 involve?
As of recent cycles, Stage 2 consists of two machine-marked papers: the Clinical Problem Solving (CPS) test and the Professional Dilemmas (PD) / Situational Judgement Test (SJT). Both are sat on the same day. The CPS tests clinical knowledge across general practice-relevant specialties. The SJT assesses professional values and behaviours. The combined score determines ranking and job allocation. Check the NRO website for the exact current format.
Is there negative marking in the GPST written papers?
No. There is no negative marking in either the CPS or the SJT papers. You should therefore attempt every question, even when uncertain. Leaving questions blank scores zero, while an educated guess has a chance of scoring a mark.
How important is the Stage 2 score for job allocation?
Very important. Your Stage 2 score (combined CPS and SJT) determines whether you are invited to Stage 3, and your overall ranking determines which training programmes and deaneries you can choose from. A higher score gives you the first pick of posts. This is why many candidates treat Stage 2 as the most critical hurdle in the process.
What is the best way to prepare for the Clinical Problem Solving paper?
Practice questions are the cornerstone of CPS preparation. Work through as many clinical scenario questions as possible across all specialties, identify your weak areas, and revise targeted content to address gaps. Timed practice is essential — time management is a genuine challenge in this paper. Resources such as Pastest, Onexamination, and ISC Medical are widely recommended.
What is the best way to prepare for the Professional Dilemmas / SJT paper?
The SJT rewards familiarity with professional values — patient safety, honesty, working within your competence, seeking help, and supporting colleagues. Read the GMC's Good Medical Practice and any GP-specific professional guidance. Then practise as many SJT questions as possible, paying close attention to the rationale for each answer rather than just the score. Resources include Emedica, gpexams.com, and ISC Medical's SJT books.
How should I prepare for Stage 3 group exercises?
Form a small revision group with colleagues you trust to give honest feedback. Practise rotating through different roles — candidate, role-player, and observer — and use scoring frameworks to provide structured feedback. Supplement this with a Stage 3 revision course, which gives you the experience of working with unfamiliar candidates. The combination of familiar-group and unfamiliar-group practice is more effective than either alone.
Are there free resources available for GPST preparation?
Yes. The NRO and NHS Health Careers websites publish practice questions and guidance documents. The BMJ Learning platform has GP-relevant clinical modules. Some deaneries publish worked SJT examples. Free trials are also available from some commercial question banks. However, for intensive preparation, most candidates supplement with paid resources such as Pastest or Onexamination.
References and Further Information
- National Recruitment Office for General Practice. GPST Application and Assessment Process. Available at: https://www.gprecruitment.hee.nhs.uk/
- NHS Health Careers. GP Training Pathway. Available at: https://www.healthcareers.nhs.uk/explore-roles/gp/gp-training-pathway
- Royal College of General Practitioners. GP Training. Available at: https://www.rcgp.org.uk/training-exams/training
- General Medical Council. Good Medical Practice. 2024. Available at: https://www.gmc-uk.org/
- ISC Medical. Get into GP Training: The Complete Guide. ISC Medical; current edition.
- Pastest. GP ST: Stage 2 Clinical Problem Solving. Pastest; current edition.
- Thandrayen N. Tips on General Practice Specialty Training (GPST) Entry 2009. ClinicalJunior.com; 2008.