Prescribing Safety Assessment

Prescribing is a complex and challenging task requiring considerable knowledge and skills. The demands on prescribers have increased because of the increased throughput of patients and more complicated treatment regimens combined with polypharmacy. Medication errors and avoidable adverse reactions are common causes of harm to patients and many involve recently qualified doctors. For these reasons, it is important that all prescribers are competent. Recent UK research, including the EQUIP study , raised concerns that the current approach to the training of junior prescribers may not be sufficient to meet the demands of the modern hospital environment. In response, the General Medical Council increased the profile of the competencies expected of doctors in its publication Tomorrow’s Doctors  (opens PDF, 506.74KB) in 2009 and highlighted the need for robust assessments to demonstrate that these outcomes have been met. 

The Prescribing Safety Assessment (PSA) was developed by the British Pharmacological Society and Medical Schools Council. Designed to be a valid and reliable assessment, it allows final year medical students to demonstrate that they have the necessary knowledge, skills and judgement (in relation to the safe and effective use of medicines) to begin their work as junior prescribers in NHS hospitals. It is an open book assessment with candidates having access to the British National Formulary (BNF) throughout. The PSA is delivered online and comprises eight sections covering different aspects of the clinical activity undertaken by prescribers (see Fig 2 below). Questions can be set in any one of seven clinical settings.

Figure 2: Prescribing Safety Assessment cycle


Fig 2 Prescribing Safety Assessment cycle

Extensive pilot studies have been under taken since 2010 and in 2015 the PSA was used by every medical school in the UK as well as some overseas schools. Increasing numbers of medical schools have now incorporated the PSA into their own schedules of assessment and make passing the PSA necessary before a degree can be awarded. Students get access to practice papers in advance, enabling them to work on the knowledge and skills that will support their future prescribing. After taking the PSA students are able to see their overall mark, and how well they have performed in each of the eight domains. Students who do not pass have the opportunity to re-sit.

The role of the PSA will continue to develop. Interest has been expressed by several other groups including medical schools outside the UK, doctors in training, independent nurse and pharmacist prescribers, and undergraduate pharmacy schools.

(See the BPS report, Clinical Pharmacology: A dynamic medical specialty essential for UK healthcare , p 18, ‘Clinical pharmacologists improve the training of the wider NHS workforce’.)

(Fig 2 reproduced from: British Pharmacological Society. Prescribing safety assessment: assessment blueprint . London: BPS, 2015. Fig 1, page 2. )

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