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Thank you for your interest in the Prescribing Safety Assessment (PSA).

The British Pharmacological Society and MSC Assessment are working together to deliver the Prescribing Safety Assessment (PSA) that allows all students to demonstrate their competencies in relation to the safe and effective use of medicines.

Candidates

If you are a medical or foundation school candidate expecting to take part in the forthcoming events (PSA 2019-20) instructions on how to register for the PSA online system would have been provided by your school. You must activate your account using the email link you have received and then login before you can access the PSA system. You are advised to do this as soon as possible in order to gain access to practice papers and information pages on the PSA.

Once you have successfully completed your account activation you will be able to view further materials to make you more familiar with the PSA assessment environment.

For general information about the assessment and its structure, click on the sections at the top of this page.

Justification

Prescribing is a fundamental part of the work of Foundation Year 1 doctors, who write and review many prescriptions each day. It is a complex task requiring knowledge of medicines and the diseases they are used to treat, careful judgment of risks and benefits of treatment, and attention to detail.

As well as offering the potential for improving health, it is an activity associated with potential hazards: a GMC-sponsored study found that 9% of hospital prescriptions contain errors ('An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education - EQUIP study'). It is also apparent in other research that this is the area of the Foundation Doctor role that new graduates find the most challenging (The state of medical education and practice in the UK report: 2014 and Be prepared: are new doctors safe to practice?). As a result, in Outcomes for graduates(originally published in Tomorrow's Doctors), the GMC defined prescribing competencies required of new medical school graduates.

The Prescribing Safety Assessment allows candidates to demonstrate their competencies in relation to the safe and effective use of medicines.

The Prescribing Safety Assessment (PSA) is a pass/fail assessment of the skills, judgment and supporting knowledge related to prescribing medicines in the NHS. The PSA assesses the prescribing skills of final-year medical students and is based on the competencies identified by the General Medical Council outlined in Outcomes for graduates (originally published in Tomorrow's Doctors). These competencies include writing new prescriptions, reviewing existing prescriptions, calculating drug doses, identifying and avoiding both adverse drug reactions and medication errors and amending prescribing to suit individual patient circumstances. The content of each item is relevant to the prescribing tasks expected of an F1 doctor, i.e. the questions refer to ailments and drugs that graduates are likely to be dealing with in year one of the Foundation Programme.

The Prescribing Safety Assessment Blueprint identifies eight different question types, each of which may be set in seven different domains of clinical activity:

Question types Domains
Prescribing Medicine
Prescription Review Surgery
Planning Management Elderly Care
Communicating Information Paediatrics
Calculation Skills Psychiatry
Adverse Drug Reactions Obstetrics & Gynaecology
Drug Monitoring General Practice
Data Interpretation

For a better idea of what assessment items look like please see the Example Question Items in the Resources section. Users who are registered by their school to take the final-year PSA gain access to interactive practice papers, which provide examples of what the assessment questions look like.

FAQs

Prescribing is a fundamental part of the work of Foundation Year 1 doctors, who write and review many prescriptions each day. It is a complex task requiring knowledge of medicines and the diseases they are used to treat, careful judgement of risks and benefits of treatment, and attention to detail.

A GMC-sponsored study found that 9% of hospital prescriptions contain errors. It is also apparent in other research (see The state of medical education and practice in the UK report: 2014 and Be prepared: are new doctors safe to practise?) that this is the area of the Foundation doctor role that new graduates find the most challenging. In response, the General Medical Council (which regulates undergraduate medical education in the UK) has placed a much greater emphasis on the prescribing competencies expected of new graduate in Outcomes for graduates (originally published in Tomorrow's Doctors).

The aim is to assess the outcomes required of newly qualified doctors in Outcomes for graduates (originally published in Tomorrow's Doctors) as they relate to prescribing. The content of each question is relevant to the prescribing tasks expected of a Foundation Year 1 doctor as outlined in Tomorrow's Doctors 2009, so the questions refer to ailments and drugs that students are likely to be dealing with in Foundation Year 1. Students taking the test can refer to the content of the online British National Formulary at any point during the assessment. While the BNF is a recommended resource, it is important to understand it does not answer all questions on prescribing.

The assessment aims to test eight distinct prescribing sections across a range of clinical contexts: prescribing; prescription review; planning management; providing information about medicines; calculation skills; adverse drug reactions; drug monitoring; and data interpretation.

Following a paper-based assessment involving over 1,300 medical students during spring/ summer 2010, an online pilot of the PSA was carried out during 2011/12 by final-year medical students from eight UK medical schools. The feedback and evaluation of these pilots has informed the development of the PSA and the delivery system.

The feedback provided by the medical schools and students who participated in these pilots was generally very positive and many students commented that they appreciated the focus that such an assessment would place on preparation for prescribing. The main purpose of the 2011/2012 pilots was to test the PSA online delivery system in a setting that closely resembled the conditions which will be faced when the PSA is implemented more widely.

The 2013 online pilot took place between February and June in the majority of UK medical schools. This was a pilot assessment designed to test the technical delivery and psychometric properties of the assessment on a national scale. The performance of those who took part did not impact on their ability to graduate. Feedback from the 2013 pilot, revolving around aspects such as the usability of the computer interface, the provision of supporting materials, and the running of venues on the day, was very positive and constructive.

Since 2014 the Prescribing Safety Assessment has been successfully organised by all UK medical schools with final year undergraduate students

The MSC Assessment and British Pharmacological Society are leading the delivery of the PSA. They are supported by the Assessment Board, and a cross-sector Stakeholder Group. The Assessment Board to the PSA is responsible for overseeing the recruitment of experts to write and review assessment items and for developing quality assurance processes. The Stakeholder Group includes a student representative from the BMA, and enables key stakeholders, including medical students, to be involved in the development of the assessment and the associated policies and processes.

The questions that ask the candidate to fill a prescription chart carry 10 marks each: 5 for the drug choice and 5 for the choice of dose/route/frequency, making a total of 80 marks for this item style in a summative assessment. Please note that timing and signature fields are automatically populated by the system and no marks are awarded for them. For more information, please look at the PSA Blueprint document.

The final year PSA will be organised in UK medical schools in the first half of 2020. Individual schools make the decision about specific dates available within an agreed national schedule.

The first sitting for Foundation Schools is September 2019, with two re-sit dates in the first half 2020.

In schools that use the PSA summatively, final-year students are required to take and pass the test in order to complete their medical degree. In other schools the assessment is formative and passing it is not a requirement for completing the medical degree. Students in these medical schools may still be required to take the assessment as a formative part of their medical education. Medical schools will communicate their requirements to their students.

By registering for the PSA, candidates agree that information about those who pass the assessment will be available to UK Foundation Schools. Those who have not passed the PSA in the two years prior to starting their F1 job will be required to pass the test before the end of their F1 year (i.e. those joining the Foundation Programme in August 2019 are required to have passed the PSA on or after 2nd February 2020). A PSA sitting will be held by Foundation Schools for those F1 doctors who have not taken or not passed at the PSA at the start of F1. Doctors will be made aware of Foundation School/employer requirements for the PSA once doctors have been matched to individual programmes by their allocated Foundation School (April onwards).

F1 doctors applying for FP 2019 who have not taken or not passed the PSA prior to graduation will be expected to take the PSA with their foundation school on 3rd September 2019. These candidates will be registered on the PSA Interface and notified by the foundation school when they can activate their accounts. Those unable to take the test in September or who fail will be placed on a programme of remediation and will re-sit the PSA in spring 2020 (all dates to be confirmed).

F1 doctors applying for FP 2019 who have not taken or not passed the PSA prior to graduation will be expected to take the PSA with their foundation school on 3rd September 2019. These candidates will be registered on the PSA Interface and notified by the foundation school when they can activate their accounts. Those unable to take the test in September or who fail will be placed on a programme of remediation and will re-sit the PSA in spring 2020 (all dates to be confirmed).

Your school will submit a list of candidates registered to take the PSA no later than four weeks before your test date. At this point, accounts will be created and the school will be informed when this is complete. The PSA Lead at your school will notify you when your account is ready to activate. If you have not received notification, please contact the PSA Lead at your school.

F1 doctors applying for FP 2019 who have not taken or not passed the PSA prior to graduation will be expected to take the PSA with their foundation school on 3rd September 2019. These candidates will be registered on the PSA Interface and notified by the foundation school when they can activate their accounts. Those unable to take the test in September or who fail will be placed on a programme of remediation and will re-sit the PSA in spring 2020 (all dates to be confirmed).

The PSA is an online assessment. The formats of the questions vary depending on what skill is being assessed; some ask the candidate to 'write' an appropriate prescription for a given problem, others ask the candidate to choose the most appropriate option from a list or to perform a calculation. Examples of what the items can look like can be seen on the Example Question Items page.

The PSA includes 60 items and is two hours in length. The length of the test may be reviewed in the future, in light of developments such as introduction of a national licensing exam and in respect of the stakeholders' views.

You will only be able to activate an account once your school has submitted a registration list for the PSA and received confirmation that the accounts have been created. This usually takes place four weeks in advance of the test date. In the first instance, please confirm with the PSA Lead at your school that they have registered you for the PSA.

If your account has been created and you are unable to activate it, or login once it is activated, please send a screenshot of the error message displayed to enquiries.psa@prescribe.ac.uk with the subject header "Login problem".

The PSA Interface provides registered candidates with links to online BNF resources - BNF and BNFc on NICE website and well as BNF and BNFc on Medicines Complete.

While paper copies of the BNF and BNFc can be allowed, including annotated ones, to be provided by the medical school or brought in by candidates, it is important to be aware that the paper versions may not contain the most up-to-date prescribing advice.PSA scoring is based on information on the BNF and BNFc websites that is most up-to-date at the time of the test. Therefore candidates are strongly advised to practice using the new online BNF and BNFc versions ahead of taking the PSA.

The BNF is a recommended resource; however, candidates should understand that it does not answer all questions on prescribing.

In 2016, OpenAthens introduced a new authentication point as a security measure, which does not allow OpenAthens to work within iframes (i.e. the PSA practice papers). In order to use the BNF and BNF for children via Medicines Complete whilst completing the practice papers you will need to open a new tab on your browser and go directly to the Medicines Complete website.

Please note that access to the Medicines Complete BNF and BNF for children is enabled by IP address in the computer venues for the PSA. You do not need your OpenAthens login for the PSA and will be able to access the BNF directly within the test interface without being prompted for login details. It is advised that you also make yourself familiar with the NICE BNF and BNF for Children which is freely available and accessible during the PSA.

30-questions-long practice papers are available to candidates who are registered to take the assessment.

Candidates are strongly encouraged to complete the practice papers on their own once they are registered to understand the timing of the assessment and how long it may take to respond to different types of questions.

Another important part of preparing for the assessment is learning to use the most up-to-date content of the online British National Formulary.

The level of difficulty of each of the practice papers is reflected by its pass mark.

Medical school staff wishing to use the practice papers as part of their teaching can be granted access through their local PSA Lead.

Medical school candidates should contact their PSA Lead or assessment office. If you’re taking the PSA at a Foundation School, please request adjustments by contacting your Foundation School.

Please make the request at the earliest opportunity to allow time to accommodate it.

After each PSA date a post-assessment review is carried out. Although the PSA is automatically marked, this review checks for any answers that did not receive an automatic mark but may be eligible for marks if prescribing guidelines have been updated since the assessment was constructed.

The post-assessment review can take a number of days depending on the assessments sat and number of candidates involved and the results will be made available up to three weeks after the PSA date.

The PSA Lead at your institution will confirm when the results will be available to you on the PSA website as soon as the information is released.

For the 2019 PSA, all medical schools may decide to offer re-sits, especially if the PSA is taken as a summative test. Medical schools where the test is formative should also offer re-sits. Medical schools are responsible for providing further training and support in prescribing for those re-sitting, and they will inform their students of the local re-sit dates.

Current F1 doctors who did not pass the test on 4th September will need to undergo remediation and have two further opportunities to retake the test on 11th March 2019 and 13th May 2019. F1 doctors for FP 2019 who did not pass the test while at the medical school will be able to sit the test at their Foundation School on 3rd September 2019, followed by two further opportunities to retake the PSA in spring 2020.

Candidates are advised to download a certificate with their performance soon after results become available on the PSA Interface in order to have a record for their future portfolio. Downloading the certificate may not be possible at a later date e.g. if the registered email address expires.

Candidates who took part in the PSA in the past and have not downloaded a certificate are advised to contact their medical school in order to receive another form of confirmation of their result.

Candidates who take part gain access to feedback on their overall score in relation to the pass mark and on their score per each domain of the assessment. The local organising institution (medical or foundation school) notifies the candidates once these results become available on the PSA Interface.

It is understandable that candidates would wish to review their results and go over the questions on which they lost marks. However, the question bank has a limited number of questions and so every question made public is in need of replacement. The development of new questions is a complex process requiring considerable time and expertise.

The bank of questions is growing steadily in the hope to eventually allow 'releasing' old questions. The practice papers available to registered candidates have a function to display detailed feedback comments about the optimal responses to each practice question.

A PSA pass is considered valid for two years. An FP 2019 applicant who has taken and passed the PSA before 2nd February 2018 will be required to take it again by their foundation school.

For F1s, the PSA certificate does not have an expiry date as such. A PSA pass within two years prior to starting the F1 year is valid, but the pass does not expire during the F1 year (e.g. if a trainee joins the foundation programme in August 2019 and passed the PSA in February 2018, the PSA certificate would not expire in February 2020 before their F1 year is complete). If trainees are required to record an expiry date in their e-portfolio it is suggested that the last date of the F1 year is entered.

Please note, if you pass the PSA at medical school and need to retake your final year, your medical school can decide whether they require you to retake the PSA or not. If you fail the repeat PSA, this will overwrite your previous pass and you will be required to pass again before completing the F1 year. The PSA status is based on your most recent attempt.

It is advised you download and save in a safe place (eg cloud-based storage) your PSA pass certificate as accounts are disabled at the end of each academic year. If you no longer have access to your account and have lost your certificate you will need to contact your medical school who can confirm your PSA pass on university headed paper and can be used in place of the certificate.

If you are a clinical pharmacologist, pharmacist or other clinician with an understanding of the prescribing duties of an F1 doctor and are interested in writing assessment items for the PSA then please state your background and register your interest by emailing enquiries.psa@prescribe.ac.uk.

Resources for prospective and current item writers are available on Item Authors page and they can also view Example Question Items.

Resources

More practice items are available to candidates who are registered by their medical school and activate their accounts.


Prescribing Item10 marks
Case presentation

A 74-year-old man presents to the medical assessment unit complaining of shortness of breath at rest and swollen legs. These symptoms have been gradually increasing over the last 2 weeks. He has been having difficulty sleeping and sat up in a chair all of last night, calling his doctor this morning. PMH. He has ischaemic heart disease and hypertension, both of which are normally well controlled. DH. He normally takes ramipril 10 mg daily, isosorbide mononitrate 60 mg daily,simvastan 40 mg nightly, aspirin 75 mg daily. An intravenous infusion of glyceryl trinitrate has just been started.

On examination

She appears distressed, and is centrally cyanosed and coughing.

Temperature 37.1-C, HR 112/min, BP 116/72 mmHg, RR 30/min, O2 sat 90% (94-99) breathing air. PEFR 120 L/min. She is using her accessory muscles to breathe. Auscultation of the chest reveals widespread wheezes bilaterally.

Investigations

Na+141 mmol/L (137-144), K+4.2 mmol/L (3.5-4.9), U 7.0 mmol/L (2.5-7.0), Cr 120 -mol/L (60-110). ECG shows sinus tachycardia. The CXR is illustrated (right).

Prescribing request

Write a prescription for ONE drug that will help to relieve his fluid overload and breathlessness.
(use the hospital 'once-only medicines' prescription chart provided)

Prescribe
Date
DD/MM/YYYY
Time
HH:MM
Medicine (Approved Name) Dose Route Prescriber Signature
including surname
Time Given Given By
Interested in item writing for the PSA?

If you are a clinical pharmacologist, pharmacist or other clinician with an understanding of the prescribing duties of an F1 doctor and are interested in writing assessment items for the PSA then please state your background and register your interest by emailing enquiries.psa@prescribe.ac.uk. Feel free to browse through the item writing templates and style guides below in order to gain a sense of what item writing involves.

Resources for authors

Please use the PSA Item Writing Manual to guide you when writing new items.

The templates and guidance below have been made available for medical schools to help prepare their students for the PSA:

Workshop presentations

Project Team presentations from the September 2015 PSA Training Workshops can be found and downloaded below.

Who's Involved

The Prescribing Safety Assessment (PSA) is being developed through four work streams led by the British Pharmacological Society and the MSC Assessment PSA Executive Board. The PSA Assessment Board is involved in item and test development. The PSA Stakeholder Group enables effective engagement of representatives from key groups including medical students and the General Medical Council. The PSA Research Group has been convened in 2015 to guide and evaluate the use of the PSA data for research.

The project has received funding from the Department of Health, Health Education England and NHS Education for Scotland to support the development and piloting of the assessment and it is currently funded by contributions from MSC Assessment and the BPS.

Information about the membership of the groups can be found using the links above.

Professor John Atherton

Lead Chair of the Medical Schools Council
Professor Malcolm Reed

Co Chair of the Medical Schools Council
Professor David Webb

Co-chair of the PSA Executive Board
President-Elect of the British Pharmacological Society
Professor Simon Maxwell, PSA Medical Director

Chair of the Stakeholder Group & Chair of the Technical Development and Delivery Group
Jonathan Brüün

Chief Executive, British Pharmacological Society
Dr Katie Petty-Saphon

Chief Executive, MSC Assessment
Professor Robin Plevin

Treasurer, British Pharmacological Society
Professor Ian Hall

Trustee, MSC Assessment
Dr Kurt Wilson

Chair of the PSA Assessment Board
Professor Val Wass

Trustee, MSC Assessment
Professor Tony Weetman

Chair, MSC Assessment
Professor Mark Gurnell

Chair, Medical Schools Council Assessment Alliance
Dr Lynne Bollington

Lead Consultant, PSA Assessment Build Observer
Professor Simon Maxwell

Group Chair, PSA Medical Director
Dr Lynne Bollington

Lead Consultant to the PSA
Professor David Webb
British Pharmacological Society

MSC Assessment /BPS PSA Exec Representative
Professor Ian Hall

MSC Assessment and Nottingham Medical School
MSC Assessment /BPS PSA Exec Representative
Dr Katie Petty-Saphon
MSC Assessment

MSC Assessment /BPS PSA Exec Representative
Khalida Wilson

NHS Employers Representative
Dr Liz Hughes

COPMeD Representative
Dr Kurt Wilson

Chair of the PSA Assessment Board
Dr Andrew Webb
King's College London

Medical School Clinical Pharmacology Representative
Dr Fraz Mir
University of Cambridge

Medical School Clinical Pharmacology Representative
Dr Ed Neville

Association of Medical Royal Colleges Representative
Professor Olwyn Westwood

General Medical Council Visitor
Professor John Atherton

Lead Chair of the Medical Schools Council
Professor Malcolm Reed

Co Chair of the Medical Schools Council
Professor Robin Plevin

British Pharmacological Society Representative
Andrew Matthewman

Health Education England Representative
Judith Chrystie

General Medical Council Representative
Charlotte Dainter

UK Foundation Programme Office Representative
Susan Redward

General Medical Council Representative
Clare Van Hamel

Foundation School Representative
Rebecca Bloor

Royal Pharmaceutical Society Representative
Jonathan Underhill

NICE Representative
Jessica Court

British Medical Association Students Committee Representative
Dr Amir Sam

Medical Schools Assessment Alliance Representative
David Burbidge

Health Education England Patient Advisory Forum Representative

The PSA Assessment Board takes responsibility for overseeing the quality assurance process, which ensures that PSA question items entered into the item bank are fit for the intended purpose and assess the prescribing-related competencies described in the blueprint. The Board selects question items from the item bank to create PSA assessments, supervises the work of the standard setting group and reviews the performance of individual items during summative assessments. The initial Assessment Board was convened during 2012.

Dr Kurt Wilson

Chair of the PSA Assessment Board
Eleanor L Dakkak

Assessment Board Member
Dr Andrew Hitchings

Assessment Board Member
Dr Rick Plumb

Assessment Board Member
Dr Mark Glover

Assessment Board Member
Dr Caroline Clark

Assessment Board Member
Dr Richard Perrett

Assessment Board Member
Dr Katie Maddock

Assessment Board Member
Dr Faye Bradshaw

Assessment Board Member
Dr Fu Ng

Assessment Board Member
Dr Heidi Northover

Assessment Board Member
Professor Simon Maxwell

Group Chair, PSA Medical Director
Dr Lynne Bollington

Lead Consultant to the PSA
Dr Celia Taylor
Warwick University

Group Chair
Professor Simon Maxwell
University of Edinburgh

PSA Medical Director
Professor Jamie Coleman
University of Birmingham

PSA Assessment Board Chair
Professor David Webb
Co-chair of the PSA Executive Board

President-Elect of the British Pharmacological Society
Professor Andy Hassell
Keele University

MSC Assessment Alliance Board

Contact Us

If you experience any difficulties, please send your enquiry in a detailed email outlining the problem to enquiries.psa@prescribe.ac.uk.

To contact the PSA Project Team: enquiries.psa@prescribe.ac.uk

To contact the British Pharmacological Society: www.bps.ac.uk

To contact the MSC Assessment: www.medschools.ac.uk