Please note that these questions are to demonstrate the format of the PSA item types only and do not reflect the actual standard of the PSA.

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

Prescribing Item
ID
PWS101
Case presentation

A 4-year-old boy is admitted urgently to a paediatric admissions unit with a sudden onset of severe breathing difficulties and an emerging rash. This began during a meal at another child’s birthday party. PMH. He is normally fit and well and is taking no regular medications.

On examination

The lips and tongue are mildly swollen. There is a widespread rash over the trunk (see image). Temperature 37.0°C, HR 160/min and rhythm regular, BP 82/56 mmHg, RR 28/min, O2 sat 96% breathing oxygen 2 L/min. There is no stridor but widespread wheezes are audible on auscultation of the lungs. Weight 20 kg.

Prescribing request

Write a prescription for ONE drug that should be administered immediately.
(use the hospital 'once-only medicines' prescription chart provided)

This question item is worth 10 marks
Prescription Review Item
ID
REV001
Case presentation

A 57-year-old man has been admitted to hospital with a lower respiratory tract infection. PMH. COPD, ischaemic heart disease. He reports that for several weeks he has a sore mouth. DH. His current regular medicines are listed (right).  He began taking antibiotics the day before admission. .

On examination

BP 98/58 mmHg.

Question A

Identify the ONE prescription that is most likely to be a cause of his sore mouth.
(mark it with a tick in column A).

Question B

Select the THREE prescriptions that are most likely to be contributing to his low blood pressure.
(mark them with a tick in column B)

This question item is worth 4 marks
Planning Management Item
ID
MAN001
Case presentation

A 54-year-old man presents to the medical assessment unit having vomited blood on two occasions during the day followed by the passage of dark coloured stool. PMH. Rheumatoid arthritis.  DH. Paracetamol 1g orally 6-hrly, ibuprofen 400 mg orally 8-hrly, methotrexate 10 mg orally weekly.

On examination

He is sweating and looks pale. HR 128/min and rhythm regular, BP 94/52 mmHg lying, 82/40 mmHg sitting, RR 18/min, O2 sat 98% (94–98) breathing air. He has a tender epigastrium and melaena stool on rectal examination.

Investigations

Hb 74 g/L (130–180).

Na+ 140 mmol/L (137–144), K+ 4.1 mmol/L (3.5–4.9), U 12.4 mmol/L (2.5–7.0), Cr 72 µmol/L (60–110).

Question

Select the most appropriate management option at this stage.
(mark them with a tick)

This question item is worth 2 marks
Communicating information Item
ID
MAN001
Case presentation

A 58-year-old man presents to his GP with pain in the right side of his jaw. DH. Amlodipine 5 mg orally daily,  simvastatin 20 mg orally nightly.

He is found to have a dental abscess and treatment with co-amoxiclav 625 mg (500/125) orally 8-hrly and metronidazole 200 mg orally 8-hrly for 7 days is commenced.

Question

Select the most important  information option that should be provided for the patient.
(mark them with a tick)

This question item is worth 2 marks
Calculation Skills Item
ID
CAL001
Case presentation

A 45-year-old man requires a daily dose of tinzaparin sodium of 175 units/kg SC daily for the treatment of a DVT. Tinzaparin sodium is available in a prefilled syringe containing 20,000 units/mL. The patient weighs 80 kg.

Calculation

What volume (mL) of tinzaparin sodium solution should be injected each day?
(Write your answer in the box below)

Answer
 
mL
This question item is worth 2 marks
Adverse Drug Reactions Item
ID
ADR101
Case presentation

A 33-year-old woman is being reviewed by her GP because of intermittent wheezing episodes. PMH. Anxiety disorder. DH. Her current regular prescriptions are listed (right). She is advised to commence treatment with salbutamol 200 micrograms INH as required. .

Question

Select the prescription that is most likely to interact with salbutamol to reduce its beneficial effects.
(mark them with a tick)

This question item is worth 2 marks
Drug Monitoring Item
ID
ADR101
Case presentation

An 83-year-old man presents to his GP with persistent aches in his shoulders and legs and severe morning stiffness.

Investigations

Hb 120 g/L (130–180), WCC 12.4 × 109/L (4.0–11.0), platelet count 420 × 109/L (150–400). ESR 54  mm/1st h (<20).

Alb 32 g/L (37–49), bili 15 µmol/L (1–22), ALT 45 U/L (5–35), alk phos 130 U/L (45–105). Serum creatine kinase 210 U/L (24–195).

CRP 43 mg/L (<10).

rheumatoid factor 15 kIU/L (<30).

He is found to have polymyalgia rheumatica and treatment with prednisolone 15 mg orally daily is commenced.

Question

Select the  most appropriate   monitoring option to assess the beneficial effects of this treatment during the first week.
(mark them with a tick)

This question item is worth 2 marks
Data interpretation Item
ID
ADR101
Case presentation

A 17-year-old girl is brought into the emergency department at 03.00 h having been found vomiting in the bathroom. She is showing signs of alcohol intoxication and says she took 20 tablets of paracetamol at 01.00 h. A plasma paracetamol concentration is taken at 07.00 h and found to be 65 mg/L. A paracetamol treatment graph is provided (see image). .

Question

Select the most appropriate decision option with regard to her treatment based on these data.
(mark them with a tick)

This question item is worth 2 marks

1 / 8

Why is an assessment of this kind needed?
What does the PSA test?
What does the assessment look like and how long does it last?
When can I activate my account?
What can I do if I am unable to activate/access my account?
In what format should I enter my signature for prescription writing items?
When will I receive my results?
Which version of the BNF should be used for the PSA?
Why can't I access the BNF in the practice papers using OpenAthens?
When will the next assessment take place?
Can I take the PSA on another date at a different school?
What is the pass mark for the PSA in 2019?
Will students need to pass the assessment?
How do re-sits work?
How long is passing the PSA valid for?
What about doctors from non-UK medical schools?
Is there a practice paper?
What resources are available to medical school staff to prepare their students for the PSA?
How was the PSA developed and piloted?
Can candidates have a certificate for the assessment?
Can candidates see where they made mistakes in the assessment?
Who is involved in delivering the assessment?
How can someone become an item writer for the PSA?

 

Why is an assessment of this kind needed?

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).

At the heart of these recommendations is patient safety. The PSA is designed to respond to them by raising the profile of prescribing in medical education so that FY1 doctors are well prepared to work in the NHS, where safety is a top priority.

 

What does the PSA test?

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.

 

What does the assessment look like and how long does it last?

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.

 

When can I activate my account?

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.

 

What can I do if I am unable to activate/access my account?

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 no later than 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 ensure you are using the Google Chrome browser on a laptop or PC, and the email address your school registered you with. The PSA website is not fully compatible with Internet Explorer or mobile devices. If you are still unable to login, please send a screenshot of the error message displayed to enquiries.psa@prescribe.ac.uk with the subject header “Login problem”.

 

In what format should I enter my signature for prescription writing items?

In the prescription writing questions, candidates are required to enter a signature correctly in order to receive a mark. Signatures should be entered in the following format: “FirstinitialSurname”. For example, if your name is Joe Bloggs, you will enter JBloggs or J Bloggs.

 

When will I receive my results?

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 no later than two weeks after the PSA date (three weeks for those registered to the February 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.

 

Which version of the BNF should be used for the PSA?

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, 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 practise using the online BNF and BNFc ahead of taking the PSA.

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

 

Why can’t I access the BNF in the practice papers using OpenAthens?

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..

 

When will the next assessment take place?

The PSA will be organised in UK medical schools in the first half of 2019.

Friday 1st February 2019

Monday 11th March 2019

Monday 13th May 2019

Friday 7th June 2019

Individual schools have already selected and confirmed the date(s) and time they will be hosting the PSA in 2019 for their students. If you are a medical student in the UK, please contact the assessment team at your school for confirmation of when and where the PSA is taking place at your school.

Current F1 trainees who did not pass the PSA on 4th September 2018 will have two further opportunities to retake the PSA on 11th March 2019 (1pm) and 13th May 2019 (1pm). Trainees joining the Foundation Programme in August 2019 who have not taken or not passed the PSA within two years of starting the programme will be expected to sit the test with their allocated foundation school on Tuesday 3rd September 2019 at 1pm. Two further opportunities to retake the PSA will take place in spring 2020. Your foundation school will contact you directly with details.

 

Can I take the PSA on another date at a different school?

No. You are required to take the PSA at your school on the date(s) they have arranged delivery of the test. If you are unavailable on your school’s scheduled date, please contact your assessment lead to discuss arrangements to take the PSA on the next available national date. If you are unable to take the PSA at your medical school, you will be expected to take it on 3rd September 2019 at your allocated foundation school. We are unable to offer independent sittings of the PSA.

 

What is the pass mark for the PSA in 2019?

The pass mark for the PSA is set using the Modified Angoff method of standard setting. The exact pass mark cannot be published before the test as adjustments may be required to take into account differences in difficulty across papers and also any issues with items identified after the test has been sat.

The passing standard of each question is defined by the Standard Setting Group, which is composed of undergraduate assessment experts from UK medical schools and representatives of the MSC Assessment Alliance.

 

Will students need to pass the assessment?

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 2018). 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).

 

How do re-sits work?

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 text 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.

 

How long is passing the PSA valid for?

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.

 

What about doctors from non-UK medical schools?

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).

 

Is there a practice paper?

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.

A demonstration paper is also available on the PSA website to allow candidates to become familiar with navigating the test pages and completing answers. Please note that this paper is for practicing using the site and the difficulty of the items does not reflect the difficulty of the PSA.

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

 

What resources are available to medical school staff to prepare their students for the PSA?

The 2019 version of the PSA Administrative Guide was circulated to PSA Leads at each medical school at the end of 2018. Example Questions are available on this website and we also advise the use of other general materials to prepare for the assessment. An important part of preparing for the exam is learning to use the most up-to-date content of the online British National Formulary, which is available to candidates during the assessment.

 

How was the PSA developed and piloted?

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.

 

Can candidates have a certificate for the assessment?

Candidates are strongly advised to download a certificate with their performance when they receive their results on the PSA Interface in order to have a record for their future portfolio. Downloading the certificate will not be possible after the end of the academic year when PSA accounts are disabled.

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

 

Can candidates see where they made mistakes in the assessment?

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.

 

Who is involved in delivering the assessment?

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.

 

How can someone become an item writer 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.

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