Pass the PSA, 1e

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As an FY1 doctor, prescribing is a fundamental part of your role, as you’ll write and review prescriptions daily. Therefore, you must demonstrate that you are competent to do so, by passing the PSA by the end of your first year of the Foundation Programme (FP). What is the Prescribing Safety Assessment (PSA)? Typically, you will be provided with 5 pieces of information and tasked with selecting the most important option to provide to the patient. Examples of the medicines that might be the focus of discussion include insulin, warfarin, salbutamol inhaler, methotrexate, or an oral hypoglycaemic medication. Know which drugs are prescribed in MICROgrams (e.g. levothyroxine, digoxin) – these are often prescribed in MILLIgrams to catch you out.

If unsure of how to manage ADR, the answers can often be found in the respective treatment summaries of the BNF. For examples – medication overdoses (poisoning, emergency treatment), hypoglycaemia (hypoglycaemia), reversal of a high INR (oral anticoagulants). For acute conditions, ABCDE is usually the first step of management. If there is an answer choice involving ABCDE, it should be the answer. If your medical school provides teaching or practice sessions for the PSA, you should attend them. Be sure to engage well with the sessions. If you don't understand anything, ask your lecturer or friends.For each question in this section, there will be a clinical scenario with results of investigations and you have to make a change to the drug prescriptions. The investigations may include plasma drug concentration. Do not memorise the normal range of values for investigations as it will be provided in the PSA questions. Do not memorise the doses of drugs apart from very commonly used drugs as that information can be found easily in the BNF. In addition to this, Dr Richard Plumb, Senior Clinical Lecturer (Education) in Therapeutics and Pharmacology at Queen’s University Belfast, has put together some resources for those sitting the exam during their F1 year and these will be shared with them prior to the examination. There are online practice PSA papers available that those taking the exam are encouraged to complete. Usually, only some of the information given in the question are relevant to the calculation. However, you should still read all the information to ensure that you don't miss anything important. You are advised to spend no more than 4 minutes for each question in the Prescribing section, no more than 3 minutes for each question in the Prescription Review section and no more than 85 seconds for each question in all other sections.

After you prescribe a drug, you have to state the dose and route of administration. For regular medicines and general practice prescriptions, you also have to state the frequency. You need not state the duration. Refer to the BNF for the correct dose, route and frequency under the right indication. Typically, you will be provided with 5 options and tasked with deciding which treatment would be most appropriate in the management of the given clinical scenario.The PSA is designed to be taken in two hours. Extra time of up to 30 minutes can be accommodated for those eligible for reasonable adjustments. The paper will consist of 60 items. For the fourth type of question, you have to determine the immediate next step of management that is most appropriate for the adverse drug reaction. It may be pharmacological or non-pharmacological management.The BNF may be able to help, but only in some cases.

Get familiar with the BNF (both online and paper versions) and know where to find things as it isn’t always obvious or easy. For example, converting opioid doses is in the palliative care summary, HRT is in the sex hormones summary, and high INR management is in the oral anticoagulants summary.After that, revise all important conditions in the Oxford Handbook of Clinical Medicine, Oxford Handbook of Clinical Specialties and the textbooks for the specialties. Your main focus should be on pharmacological management, but diagnosis, investigations and non-pharmacological management are important too. Pay attention to the frequency and duration of the prescriptions in the question. The question may require you to perform some calculations on that. You must make sure that there are no contraindications or allergies to any drug you want to prescribe. The list of contraindications of each drug is available in the BNF. Prescribing a drug that is contraindicated will likely cause you to score 0 mark for the whole question. The recommended reference books for the PSA are Pass The PSA, Get Ahead! The Prescribing Safety Assessment, MasterPass Student Success in the Prescribing Safety Assessment, Oxford Handbook of Clinical Medicine (10th Edition), Oxford Handbook of Clinical Specialties (10th Edition) and the textbooks for the specialties. Note that the questions in the MasterPass Student Success in the Prescribing Safety Assessment book are not well aligned with the PSA format, but it's still useful to do them as a practice. Here you will be given a clinical scenario and asked to decide which treatment would be most appropriate from several plausible answers.

You will not be allowed to bring anything into the exam other than a calculator, pencil, pen and the paper version of the BNF. You will have online access to the BNF and NICE guidelines throughout the exam. Get ahead! The Prescribing Safety Assessment’ by Muneeb Choudhry, Nicholas Rubek Fuggle and Amar Iqbal Take into consideration specific information you are given about a patient when deciding which piece of information is best – e.g. are they of childbearing age?There may be more than one correct management options, but one will be better than the others. Ensure that there are no contraindications to a particular management option before selecting it. You can look up the BNF for the contraindications of each drug. The PSA is assessing that you have achieved the core competencies outlined in the GMC’s Outcomes for Graduates for ‘prescribing medicines safely’. Ensuring that you’re aware of what is included will undoubtedly go some way to helping you understand what will be expected of you in the exam. Use PSA practice papers