Download PSAExampleQuestionItems.pdf or view below.

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 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

HR 105/min and regular, BP 110/70 mmHg, JVP elevated at 6 cm, HS third heart sound, RR 30/min, O2 sat 93% on air. Examination of the chest reveals dullness to percussion both bases and fine inspiratory crackles both lower and mid zones. Bilateral swollen legs with pitting oedema to knees.

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 µmol/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)

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

A 57-year-old man with chronic obstructive pulmonary disease and ischaemic heart disease has been admitted to hospital with a lower respiratory tract infection. He began taking antibiotics the day before admission. He has complained for several weeks that he has a sore mouth. His blood pressure on admission is 98/58 mmHg. His current regular medicines are listed (right).

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

Idenftiy 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
Management Planning Item
ID
MAN001
Case presentation

A 70-year-old woman is admitted with breathlessness and a cough productive of green sputum. She tells you that her breathing has been getting worse for several months but this is the first time that she has come to hospital. PMH. Hypertension. DH. Amlodipine 5 mg daily, salbutamol inhaler 2 puffs as required. SH. Longstanding smoker.

On examination

Temperature 36.8C, HR 96/min and regular, BP 170/92 mmHg, RR 22/min, O2 sat 96% on air. Respiratory examination reveals a widespread expiratory wheeze.

Investigations

CXR shows hyper-expansion of the lung fields and some old scarring at the left apex but no other significant findings.

Question

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

This question item is worth 4 marks
Calculation Skills Item
ID
CAL001
Case presentation

An 8-month-old boy weighing 9 kg requires a dose of midazolam 2.5 mg to be administered buccally for febrile convulsions. Buccal midazolam liquid is available as a 10 mg/mL solution.

Calculation

What volume of liquid should be administered?
(Write your answer in the box below)

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

A 67-year-old man has started to take morphine sulphate (Sevredol®) 10 mg orally 4-hrly for pain associated with a gastric carcinoma.

Question

Select the adverse effect that is most likely to be caused by this treatment.
(mark them with a tick)

This question item is worth 2 marks
1 / 5

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?
Which version of the BNF should be used for the PSA?
When will the next assessment take place?
What is the pass mark for the PSA in 2016?
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 is the assessment being 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 developing 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.

 

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. In September 2015, Medicines Complete launched a new online version of the BNF and BNFc. The legacy versions of the BNF and BNFc are still available via the Medicines Complete landing page.

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.

 

When will the next assessment take place?

The PSA will be organised in UK medical schools in the first half of 2016. Individual schools make the decision about specific dates available within an agreed national schedule.

 

What is the pass mark for the PSA in 2016?

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.

 

Will students need to pass the assessment?

From 2016, all F1 doctors will be expected to pass the PSA before starting at their foundation schools to demonstrate their prescribing competency. Those who have not taken the PSA or who have previously failed will be expected to take the PSA during their induction week.By registering for the PSA 2016, candidates agree that information about those who pass the assessment will be available to UK foundation schools.

Some medical schools also require their final year students to take and pass the test in order to complete their medical degree, and in these medical schools the assessment will be summative. In other schools the assessment will be formative and passing it will not be a requirement for completing the medical degree.

However, students in these medical schools are still required to pass the assessment before they start their F1 role. Those who have not passed will be required by their Foundation School to take the PSA during their induction week.

 

How do re-sits work?

For the 2016 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.

Those F1 doctors who have not taken or not passed the PSA while at medical school will be expected to sit the test during their Foundation Programme induction week.

 

How long is passing the PSA valid for?

A PSA pass is considered valid for two calendar years. An FP 2016 applicant who has taken and passed the PSA before 2015 will be required to take it again by their foundation school.

 

What about doctors from non-UK medical schools?

F1 doctors who have not taken or not passed the PSA prior to graduation will be expected to take the PSA during their induction week. These candidates will be registered on the PSA Interface by their foundation school and notified by the foundation school when they can activate their accounts.

 

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. This is in order to become familiar with the features of the PSA Interface, 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.

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 2016 version of the PSA Administrative Guide has been circulated to PSA Leads at each medical school at the end of 2015. 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 is the assessment being 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.

In 2014 and 2015 the Prescribing Skills Assessment was organised successfully by all UK medical schools with final year undergraduate students.

 

Can candidates have a certificate for the assessment?

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.

 

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 British Pharmacological Society are leading the delivery of the PSA. They are supported by the Assessment Board, a Technical Capacity and Delivery Group and a cross-sector Stakeholder Group and a Research 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 prescribingskillsassessment@bps.ac.uk.

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