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.
All Year 5 students should be aware of your Assessments site within the MBChB tab on Blackboard that contains all the information you will need relating to the PSA.
Make sure to check out the Powerpoint slides for useful information on the type of question that will appear and how to approach them.
The mock PSA taken in Year 4 lasts for one hour. The real PSA exam taken in Year 5 lasts for two hours.
Well in advance of the exam, you should familiarise yourself with your PSA personal login details. On the day, once logged in, you will need to click on Assessments, and will be asked to enter an event password to begin.
Once you begin the exam you will have access to both the NICE and Medicines Complete version of the BNF. You shouldn’t need to log in to either, but in the event of any technical problems it is worth familiarising yourself with your OpenAthens account details so you can log in if you need to.
As you progress through the exam, the answers you enter will be saved as you go. So if you accidentally close your browser tab or window, or if it crashes – you will be able to return to prescribingsafetyassessment.ac.uk and log in (you may well need to enter the event code again). You can then return to the question you were last answering. Use the dashboard as shown below to keep track of the questions you haven’t yet answered.
It is very important to remember that when answering certain questions you will need to start typing an answer, and then select from a list of possible options. If you quickly type in an answer that is not in the correct format, it will not be saved. You should check that you are comfortable answering PSA questions by doing practice tests before the assessment date.
If you have any problems with not being able to complete a question because of a technical issue, you should call an invigilator who will be able to advise you.
As you advance through questions, you will notice their corresponding numbers in the dashboard will change colour as you complete them. The question you are currently on will be shown in blue. If the question ‘number’ is white, it means the question hasn’t been answered.
PSA Question numbers
Some questions will require you to enter a specific dosage or frequency, and in these instances the PSA has a specific set of acceptable terms you will need to use. You can find these within the exam by pressing the [A] button in the top of the exam dashboard (as shown in the screenshot below). For example, if asked to complete the frequency on a prescribing question, instead of typing ‘daily’ you should type ‘once’ and select ‘once a day’ from the dropdown box that will appear.
Once you get to the end of the exam and have completed all the questions, make sure you proceed to the final question and press Exit.
Logging in to https://prescribingsafetyassessment.ac.uk/ with your username and password will give you access to a practice test. You will be able to familiarise yourself with the user interface, try out some sample questions and get used to accessing the NICE BNF.
If you are preparing for the Year 4 mock PSA sitting you can find some example questions, FAQs and other useful information on the PSA website without logging in, and the ‘Prepare for the PSA’ website (mentioned below) is also a good source for question samples.
Also make sure to read up on the PSA assessment structure – once logged in, click on ‘Assessments’ and then ‘Understanding PSA Score’ as it informs you how the marks are weighted for the different sections of the exam.
During the Year 5 PSA exam, you will NOT need a password for MedicinesComplete. However, if you want to use this site whilst you are practising for the exam, you will need to use your OpenAthens account. You can find out more about accessing MedicinesComplete here.
The NICE version of the BNF can be accessed here – it does not require a password.
You are allowed to take a paper version of the BNF into the exam as well. However, it must NOT be annotated, and you should make sure it is the most up-to-date version (as drug advice can sometimes change between versions). Also, it is generally much faster to use the web-based BNF.
There is a NICE BNF phone app freely available too. This can be a really useful tool whilst seeing patients and writing prescriptions on the wards. However, you will NOT be allowed this during the exam, so it is important to familiarise yourself with the websites.
Things to bring to the exam (or not!)
- A calculator
- A pencil or pen
- An un-annotated and up-to-date version of the paper BNF
- You are NOT allowed your phone
Practise using Google Chrome as it will be used to run the exam. Below are a list of useful keyboard shortcuts for both Google Chrome and Microsoft Windows that can make you more efficient when it comes to browsing and navigating the PSA pages. You can find more here!
Quick Find: Ctrl+F
|Windows Key + Left/Right arrow||Push the active window to the side of the screen|
|Windows Key + Up arrow||Enlarges the current window, keep pressing to maximize.|
|Windows Key + Down arrow||Shrinks the current window, keep pressing to minimize.|
|Ctrl + F||Opens the ‘Find’ search box, lets you search the page for any text you enter.|
|Ctrl + C||Copies the selected text|
|Ctrl + V||Pastes the selected text|
Google Chrome Shortcuts
|Ctrl+N||Opens a new window.|
|Ctrl+T||Opens a new tab.|
|Press Ctrl+Shift and click a link||Opens the link in a new tab and switches to the newly opened tab.|
|Press Shift and click a link||Opens the link in a new window.|
|Ctrl+Shift+T||Reopens the last tab that you closed.|
|Drag a link to a tab||Opens the link in the tab.|
|Drag a link to a blank area on the tab strip||Opens the link in a new tab.|
|Drag a tab out of the tab strip||Opens the tab in a new window.|
|Ctrl+1 to Ctrl+8||Switches to the tab at the specified position number on the tab strip.|
|Ctrl+9||Switches to the last tab.|
The interactive video below shows some of the keyboard shortcuts at work and how they look within the context of the PSA website. Please feel free to pause and re-watch the video as many times as you need.
- Essential Practical Prescribing (Hawkins, Stanton, Phillips)
- Pass the PSA (Brown, Loudon, Fisher)
- The Unofficial Guide to Prescribing (Qureshi, Maxwell)
Prepare for the PSA is an online tutorial that was created by one of our Medical Students with the guidance and support of Dr Robert Baker. The main section of the tutorial is a practice exam, with personalised feedback and interactive learning exercises after each question. Please note that the content of this resource is not being updated, so may appear significantly different to current versions of the exam.
- Gentamicin monitoring and dosing using the Hartford nomogram
- Vancomycin monitoring and dosing
- Digoxin monitoring
- Lithium monitoring
- Aminophylline infusions – calculate a volume or quantity to be added to the infusion
- Thyroxine dose adjustment
- Post-operative fluids
- Simple pain relief
- Side effects of psychiatric drugs eg neutropenia
- Adjusting doses in renal impairment
- Understanding percentage calculations
- Monitoring of therapeutic response to a drug. Might be weight loss with diuretics, or exercise tolerance with ACEI, or CRP with antibiotics, or ESR with polymyalgia
- Management of high INR on warfarin with or without bleeding
- Writing up blood products e.g. packed cells
- Do the practice papers on the official PSA website – and use the feedback to see why some of your answers were wrong
- The exam is very time pressured – so do all the practice papers and get used to the time limit
- For the prescribing questions, familiarise yourself with looking up drugs in the web-based BNF. Once you’ve found the drug you want:
- double check the dose/etc. for that particular clinical indication
- ensure there are no contraindications or need for dose adjustments (e.g. elderly, renal/hepatic impairment) listed in the text of the case
- quickly check for drug interactions with any of the other medicines listed in the patient’s drug history – it is worth searching for not just the drug, but the drug class too
- Remember the BNF has advice on how to treat a wide range of diseases – it is not just a dictionary of drugs!
- Practice the drug calculations – these are basic “high school” maths:
- remember 0.5% = 0.5g in 100ml = 5g in 1000ml = 5000mg in 1000ml; for adrenaline 1 in 1000 means 1 mg/ml, 1 in 10000 means 1mg/10ml
- take your time – although you can often do the calculations in your head, it is often safer to write each step down on paper to avoid doing something dumb (e.g. dividing X by Y, rather than Y by X)
- Read PSA blueprint to identify potential areas of weakness
- Familiarise yourself with the “key drugs” listed in the PSA section of the Year 5 Assessments & Feedback pages on the MBChB tab in Blackboard.
- Practice writing prescriptions on the ward – and get someone (a pharmacist is sensible!) to check it.