The electronic Knowledge Assessment (eKA) — administered by the College of Sexual and Reproductive Healthcare (CoSRH, formerly FSRH) — is the mandatory theory assessment that gates access to the DFSRH Diploma and the Letters of Competence (LoC SDI for implants, LoC IUT for intrauterine devices). If you want to fit coils or implants in the UK, you must pass the eKA first.
Since eligibility expanded beyond doctors to include nurses, midwives, physician associates, and pharmacists, the candidate pool has grown significantly. Yet preparation resources remain surprisingly limited.
The format
The eKA is an online, remotely proctored SBA exam. You have 28 days from payment to complete it (recently extended from 7 days — a welcome change). The exam draws questions from the CoSRH question bank, covering the theoretical knowledge underpinning all FSRH/CoSRH qualifications.
The questions are single best answer format, testing knowledge of: all contraceptive methods (mechanism, efficacy, indications, contraindications, drug interactions), UKMEC categories, emergency contraception, STI screening and management, pregnancy choices, and relevant anatomy and physiology.
The standard expected is that of a clinician competent to provide contraceptive care in primary care — not specialist level, but thorough and guideline-aligned.
What's actually tested
The eKA is heavily weighted toward UKMEC (UK Medical Eligibility Criteria) and FSRH/CoSRH Clinical Effectiveness Unit (CEU) guidelines. If you know these two resources thoroughly, you'll pass.
High-yield topics:
UKMEC categories for every method — particularly combined hormonal contraception (interactions with age, smoking, BMI, migraine with aura, breastfeeding), IUD/IUS (PID history, nulliparity, uterine anomalies), and emergency contraception (ulipristal acetate timing relative to hormonal restart).
Drug interactions with contraception — enzyme-inducing drugs (rifampicin, carbamazepine, phenytoin) and their effect on efficacy. The specific guidance on managing breakthrough bleeding or missed pills when enzyme inducers are involved.
Quick-starting contraception — the CoSRH guidance on initiating contraception outside the traditional "day 1–5" window, including bridging with emergency contraception.
Emergency contraception — timing, efficacy comparison (levonorgestrel vs ulipristal vs copper IUD), and the interaction between ulipristal and subsequent hormonal contraception.
Switching between methods — the rules for switching without loss of contraceptive cover between pills, patches, rings, injectables, implants, and IUDs.
Contraception in specific populations — postpartum, breastfeeding, adolescents (Fraser competence/Gillick competence), perimenopause, post-abortion.
How to prepare
Start with the CEU guidelines. Read every current CoSRH/FSRH CEU guideline cover to cover. They're freely available on the CoSRH website. These are the primary reference for the exam — the questions are written to test guideline knowledge, not textbook knowledge.
Master the UKMEC table. Print it. Pin it to your wall. Know every Category 3 and Category 4 entry. This is the single most tested document. A candidate who knows UKMEC cold will pass regardless of anything else.
Use PasSRH for practice questions. PasSRH is the main dedicated resource for CoSRH exams. Their Diploma question bank covers eKA-level content. It's the closest thing to a dedicated eKA qbank that exists. Worth the subscription.
The Guillebaud textbook (Contraception: Your Questions Answered) is excellent for understanding the reasoning behind guidelines. Not essential for passing the eKA, but helpful for the clinical practice that follows.
AI tools for gap-filling. The eKA tests guideline-specific knowledge that AI clinical search tools handle well. Queries like "UKMEC category for combined pill in a breastfeeding woman at 4 weeks postpartum" have definitive guideline-based answers. iatroX covers NICE and FSRH-adjacent contraception content. Use it to test yourself on edge cases.
Common mistakes
Applying general knowledge instead of CoSRH-specific guidance. The eKA rewards guideline-faithfulness. If the CoSRH guidance says one thing and your clinical experience says another, the CoSRH guidance is the correct answer for the exam.
Underestimating the drug interaction content. Enzyme-inducing drugs and contraceptive efficacy is a consistent testing area that many candidates find more complex than expected.
Not reading the updated guidance. CoSRH/FSRH guidelines are updated regularly. Make sure you're reading the current version, not a summary from 2019.
The bigger picture
The eKA is the first step in a qualification pathway. After passing, you proceed to supervised clinical training for the specific qualification you're pursuing (DFSRH Diploma, LoC SDI, LoC IUT). The clinical training involves face-to-face sessions with a CoSRH Registered Trainer and practical competency assessments.
The eKA itself is not the hard part — the clinical training that follows is where the real skill development happens. But the eKA is the gateway, and failing it delays everything. Invest 2–3 weeks of focused preparation, centre it on CEU guidelines and UKMEC, and you'll be through.
iatroX offers AI clinical search covering UK contraception and women's health guidelines. UKCA-marked medical device built by a practising NHS GP.