Published November 28, 2023 | Updated January 31, 2024
By Kuvira Manamperi
Hey there! I’m Kuvira, a junior doctor trying to navigate my way through NHS. I’m excited to share my insights and experiences with you!
What is the Prescribing Safety Assessment?
The Prescribing Safety Assessment (PSA) is a collaborative effort between the British Pharmacological Society and MSC Assessment.
This online assessment is a pass/fail evaluation that gauges the prescribing skills of final-year medical students. It aligns with the competencies defined by the General Medical Council (GMC) in their “Outcomes for Graduates” document.
These competencies encompass essential tasks, including:
The assessment’s questions focus on medical conditions and medications commonly encountered by new doctors in their first year of the Foundation Programme.
Why is the PSA Necessary?
Prescribing is a pivotal responsibility for Foundation Year 1 doctors, who routinely issue and review numerous prescriptions. This role involves a multifaceted skill set, demanding knowledge of medicines, their applications in treating diseases, careful assessment of risks and benefits, and meticulous attention to detail.
Prescribing comes with inherent risks, with research supported by the GMC revealing that 9% of hospital prescriptions contain errors. It is also a challenging aspect for recent medical graduates, as underscored by various studies. Interestingly enough, some studies have shown a higher error rate for FY2 doctors than FY1 doctors.
The Prescribing Safety Assessment serves as a means for candidates to showcase their proficiency in the safe and effective use of medications, ensuring they meet the requisite competencies.
The PSA plays a crucial role in the successful completion of your Foundation Year 1 and is a fundamental requirement for a favourable outcome in your Annual Review of Competence Progression (ARCP).
Who Should Take the Exam?
The Prescribing Safety Assessment is primarily designed for final-year medical students and international graduates who are on the path to becoming Foundation Year 1 Doctors.
If candidates have not taken it earlier or did not pass it, they have the opportunity to complete it during their Foundation Year 1 (FY1) training.
How Much Does it Cost?
Here’s the sweet deal: The PSA is absolutely free.
Yep, you read that right. No need to break the bank for this assessment.
About the Exam
Structure & Domains Covered
The Prescribing Safety Assessment Blueprint outlines eight different question types that can be related to seven different clinical domains:
The exam is structured into 8 different sections (questions involve a mix of domains above):
The PSA consists of 8 sections worth a total of 200 marks and has a time limit of 120 minutes (2 hours).
Quick Guide to Each Domain
Timing Guide
Because the PSA is time-sensitive, effective time management is crucial. Here’s a guide from Mind The Bleep on how much time to allocate to each section based on their importance:
| Sections | Number of Questions x Marks | Timing guide |
| Prescribing | 8 x 10 marks (5 for drug choice, 5 for choice of dose/route/frequency) | 48 minutes |
| Prescription review | 8 x 4 marks | 19 minutes 12 seconds |
| Planning management | 8 x 2 marks | 9 minutes 36 seconds |
| Providing information | 6 x 2 marks | 7 minutes 12 seconds |
| Calculation skills | 8 x 2 marks | 9 minutes 36 seconds |
| Adverse drug reactions | 8 x 2 marks | 9 minutes 36 seconds |
| Drug monitoring | 8 x 2 marks | 9 minutes 36 seconds |
| Data interpretation | 6 x 2 marks | 7 minutes 12 seconds |
High-Yield Medications
Expect the Prescribing Safety Assessment to have at least two questions about these drugs, so make sure you know them reasonably well:
Other common drugs to be aware of:
Question Types in the PSA
Each Prescribing Safety Assessment question follows a set structure. You are given a clinical scenario and then asked a question to do with this scenario. There are four types of questions you could be asked:
Note: These example PSA questions are just examples to demonstrate how questions may typically be presented.
1. Single Best Answer Questions
The key here is “best” – you are likely to be given at least two options which are reasonable, but must choose the most appropriate answer for each case. This is used when planning medicines management, dealing with drug reactions, and interpreting data and drug monitoring.
2. Prescribing Questions
You will be asked to prescribe a medication, including the drug, dose, route, and frequency, using best practice.
3. Select Answers From a List – Prescription Review
This will likely be in a review of prescriptions, in which you will have to select one or more drugs from a list of medications.
4. Written Answers – Calculations
For answering questions to do with dose calculation.
Prescribing Safety Assessment Exam Dates
The PSA exam is taken at the end of the final year of medical school across the UK, but is not a requirement to start practising. Dates for “1st attempts” of UK graduates will be given to you by your medical school.
If you don’t pass on this attempt, or you are an International Medical Gratuate, you still have a chance to pass at a later date.
For those current foundation doctors who are yet to pass, the PSA dates for 2024 are:
Tuesday 12th March 2024, 1pmTuesday 23rd April 2024, 1pm
Success Rate and Pass Mark
The passing score for the PSA is determined using the Modified Angoff method. In the Modified Angoff Method, the passing score for the exam is calculated using expert opinion on how many questions a “borderline” candidate (expected to just scrape a pass) should answer correctly, taking biases into account.
The specific passing score isn’t disclosed in advance because it may need adjustments based on variations in test difficulty and any item-related problems identified after the test. Although the PSA test may seem challenging, most test-takers pass it, with the typical median score being approximately 75%, and the passing score often roughly 62-63%.
Preparing for the Exam
Revision Resources I found useful
Pass the PSA
by Will Brown, Kevin W. Loudon, James Fisher, Laura Marsland
*Note – To pay our website costs, we earn commissions from any purchases via this link.
Pros
Cons
2. Practice Papers on the PSA Website
3. Mind The Bleep PSA Course
Using the BNF (British National Formulary)
During the assessment, you can use the online BNF as your go-to resource for Prescribing Safety Assessment questions. The BNF is a rich source of information about medicines and is available on the NICE website or Medicines Complete. However, keep in mind that the PSA is a time-sensitive exam, so while the BNF is your “Best Nifty Friend,” you’ll still need some prior knowledge about prescribing to do well.
Since the BNF is electronic, you can quickly find specific information by using the CTRL+F to quickly search for the keyword you’re looking for.
In order to make the best use of the BNF on the day of the PSA, make sure you can use it to quickly:
Before the Exam
Registering and Activating Your Account
Your medical school will send a list of students taking the PSA about four weeks before the test. They’ll create accounts and tell the school when it’s done.
Your school’s PSA leader will let you know when you can activate your account. If you haven’t heard from them, just ask your school’s PSA leader.
Preparing
You should log in to your account and test your access to the PSA interface and the BNF before the exam day. On the exam day, laptops will be provided by the venue.
The team will set them up in the morning to ensure they work with both of these sites. It’s a good idea to arrive 45 minutes early to make sure you can log in without any problems.
On the Day
On the exam day, make sure to:
Remember, you won’t be allowed to use any personal electronic devices during the assessment, and you can’t use a calculator that’s part of another device, like a phone.
Remember – Life Happens
One important thing to note: If you can’t make it to your PSA sitting, please let them know as soon as possible, but no later than two working days before the PSA date.
If something comes up on the day of the exam, you must submit an extenuating circumstances form no later than one working day after the test.
Moment of Truth… Results Day
Your PSA results will be ready for you to check out when you log into the PSA website.
Just head to the “My Profile” section, and you’ll find your Assessment Feedback around two weeks after the test.
You’ll also get an email from the foundation school to let you know when your results are ready.
When you’re looking at your results, make sure to download and save a copy of your certificate. Keep in mind that accounts get disabled at the end of the academic year. So, after that time, you won’t be able to access your certificate anymore.
Top Five Tips
You’ve got this!
In a nutshell, when prepping for the PSA, practice is your best buddy. You’ve got to get cozy with the BNF and dive into practice questions before the actual deal.
Why? Well, practice builds your confidence and sharpens your skills for handling different scenarios and question types. So, when it comes to gearing up for the PSA, keep it simple: Practice, practice, practice. It’s the name of the game for acing this assessment!
If you don’t pass on your first attempt, don’t worry. You can give it another shot on the upcoming test dates mentioned earlier. Just make sure to pass it before the end of your FY1.
