The PSA is based on the competencies identified in the General Medical Council’s Outcomes for graduates (originally published in Tomorrow’s Doctors), such as 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 eight distinct prescribing areas: prescribing, prescription review, planning management, providing information about medicines, calculation, adverse drug reactions, drug monitoring and data interpretation, are delivered over two hours. The content of each question refers to ailments and drugs you are likely to encounter in year one of the Foundation Programme. The question may ask you what is the monitoring required before starting the drug or how to monitor for beneficial effects or adverse effects after starting the drug.

The exam assesses your competencies in relation to the safe and effective use of medicines. It is designed as a tool for demonstrating that you have achieved the core prescribing competencies as outlined in the GMC’s Outcomes for Graduates. In the real assessment, the post-assessment review process considers every unrecognised answer and all credit-worthy answers are added to the mark scheme to enable marks to be credited. There are many textbooks available to help prepare for the PSA, useful for becoming accustomed to the exam structure, common high yield drugs and practising calculations. However, many are set at a level easier than the actual exam. The books I used were: For questions about the monitoring for beneficial effects, you need to use your clinical knowledge and judgement to determine to most appropriate monitoring option. The information about that is not usually available in the BNF.Another key way of familiarising yourself with the PSA exam and what will be assessed is to complete practice tests. Once you are registered for an exam date, you’ll be given access to three PSA practice papers to facilitate your preparation for the exam. These are a really useful starting point. To ensure that you are fully prepared, you should utilise these alongside further practice tests, to give you plenty of opportunities to practise answering the types of questions you’ll encounter within the given time. Remember time is a key factor in the PSA which is what makes it such a difficult exam. Therefore, practising completing the exam within the time limit is great preparation! Explore the BNF content Know where to find things e.g. often important information to communicate about a drug is in the ‘patient and carer advice’ section. I commonly used this section during the exam.

For fluid prescriptions, you have to state the volume and duration. Information on the correct volume and duration is not usually available in the BNF, so this requires your clinical knowledge and judgement. The treatment summaries can help in this section if you are not sure what drug should be used. However, having a good basic understanding of most conditions allows you to focus on looking up the appropriate drug based on your prior understanding which helps save time. My ability to answer a lot of the questions was based on my knowledge from finals and my familiarity with Medicines Complete. Some of my friends got stressed about the PSA as an added exam on top of finals and the SJT but if you set aside a little time each week and review your pharmacology knowledge you are not only preparing for the PSA but you are also preparing for finals. The maximum dose of paracetamol is 1g QDS – common dosing errors will include 1g 4hrly or co-prescription of paracetamol and co-codamol.

The PSA exam is 2 hours long, with an extra 30 minutes available if you’re eligible for reasonable adjustments. In some cases, the question will tell you the diagnosis, while in other cases, you have to determine the diagnosis based on the information given. The BNF won't usually help you in determining the diagnosis, so your clinical knowledge and judgement is needed.