Prescribing Safety Assessment

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The Prescribing Safety Assessment is an online assessment of competency in the safe and effective prescribing of medicines, taken by final-year medical students and by overseas graduates coming to the UK to work as Foundation Year 1 doctors. It is developed and run jointly by MSC Assessment and the British Pharmacological Society. 

The assessment is based on competencies set out in the General Medical Council’s Outcomes for graduates (previously Tomorrow’s Doctors), with questions that are relevant to the prescribing tasks of a Foundation Year 1 doctor. This includes writing and reviewing prescriptions, calculating doses, and identifying adverse drug reactions. The assessment lasts two hours and comprises 60 questions. It is a pass/fail assessment and, since 2016, it is a requirement to have passed before starting Foundation Year 2. The performance of the assessment is analysed annually by an independent expert and reviewed by the PSA Assessment Board.  

Experts from the medical schools author and quality-assure the questions while administrative staff from the medical schools form part of the UK-wide organisational effort which goes into its delivery. The assessment was  made possible through financial contributions and staff time from MSC Assessment and the British Pharmacological Society, as well as by funding from Health Education England and NHS Education Scotland. More information can be found on the Prescribing Safety Assessment website.

History

The case for creating the assessment came from a 2009 study from the General Medical Council. The study found that 9% of hospital prescriptions contained errors, while subsequent research indicated that prescribing is the area which graduates find most challenging. Prescribing assessments had already been developed and were in use locally by medical schools and hospitals, but there was no nationally accepted measure of prescribing performance.

The Medical Schools Council and British Pharmacological Society together created an assessment to address this, piloting over 2012 and 2013. Following successful pilots, the Prescribing Safety Assessment was implemented in 2014 across all medical schools, with each free to choose whether they set the assessment as a necessary step to graduation or not. At this time, the Medical Schools Council’s contribution to the assessment was assumed by the newly formed MSC Assessment.

In late 2015, health officials from the four UK countries stipulated that from August 2016 all new Foundation Year 1 doctors would be required to pass the Prescribing Safety Assessment in order to progress to Foundation Year 2.

Research

The PSA Executive Board invites research applications in the following areas listed in the order of priority:

  • An analysis of the most common prescribing errors made on the PSA, with feedback to medical schools.
    Status: one application accepted
  • Formal Rasch Analysis of PSA scores to make recommendations on how best to enhance reliability, particularly around the pass mark.
    Status: completed in annual psychometric report
  • Relationship between PSA scores and workplace prescribing performance (including safety), using data generated from Trust electronic prescribing systems, case-note review, pharmacist review of prescriptions, incident reports or other sources.
    Status: applications welcome
  • Relationship between PSA scores and prescribing behaviour observed in contexts such as Trust-based assessments, workplace-based assessments or Educational Supervisor ratings.
    Status: applications welcome
  • Prediction of PSA scores from UKCAT scores, in particular the numerical component of the UKCAT and calculation skills items on the PSA.
    Status: applications welcome
  • The acceptability of the PSA among medical schools, including the factors affecting the decision of whether to use the PSA formatively or summatively, the barriers to using the PSA summatively and how these could be overcome.
    Status: applications welcome
  • The effect of change of use of the PSA within a medical school (from formative to summative) on student behaviour and performance.
    Status: applications welcome
  • The effect of preparing for and taking the PSA on students’ views of their preparedness to practise.
    Status: applications welcome
  • The effect of additional time on behavioural approaches to the assessment, completion and performance for students with dyslexia.
    Status: one applications accepted
  • Further examination of the correlations between scores on different sections of the PSA.
    Status: applications welcome
  • Relationship between PSA and nationally used shared prescribing OSCE stations developed by the Medical Schools Council Assessment Alliance.
    Status: applications welcome
  • Relationship between PSA scores and those from other (existing) medical school assessments.
    Status: applications welcome
  • A study of the cognitive demand of the PSA, incorporating data from analysis of keystrokes, length of time spent reading, frequency of changing responses and patterns and amount of time spent searching the British National Formulary.
    Status: applications welcome
  • The acceptability of the PSA amongst medical students.
    Status: applications welcome
  • The effect of the PSA on learning behaviour by medical students, for example the use of the PSA Interface (and other) preparation materials, the relationship between the PSA and teaching at medical school and/or the impact on learning in other curriculum areas.
    Status: applications welcome
  • Relationship between PSA scores and Royal College examination results, in particular prescribing-focused questions.
    Status: applications welcome
  • The effect of the PSA on medical schools’ attitude towards the teaching and learning of prescribing using a longitudinal comparison of curricula within and between schools.
    Status: applications welcome
  • Development, implementation and evaluation of an intervention to enhance prescribing skills/performance on the PSA.
    Status: applications welcome
  • The acceptability of the PSA amongst other stakeholders (for example employers, patients).
    Status: applications welcome
  • Relationship between PSA scores and specifically developed simulation exercises.
    Status: applications welcome
  • An investigation of how students approach items in the assessment, for example using the theory of planned behaviour.
    Status: applications welcome

If you are considering making an application, we encourage you to contact the Prescribing Safety Assessment team to receive advice and support in understanding the data available. Please note that research projects should be self-funded.