The Online Theory Assessment is the written knowledge component of the DFSRH. Fifty multiple-choice questions in one hour, taken online. It tests the theoretical knowledge that underpins safe contraceptive and sexual health practice — and it is more demanding than many candidates expect.
The OTA is not a test of basic contraception awareness. It tests specific clinical scenarios requiring detailed knowledge of UKMEC categories, drug interactions, STI management protocols, and contraceptive decision-making for complex patients. Candidates who prepare superficially — reading a few guidelines without systematic Q-bank practice — frequently fail.
What the OTA Tests
Contraceptive methods in detail. Every method: combined hormonal contraception (CHC — pill, patch, ring), progestogen-only pill, progestogen-only injectable, subdermal implant, intrauterine system (IUS), intrauterine device (IUD), barrier methods, and emergency contraception (levonorgestrel, ulipristal acetate, copper IUD). For each method, know the mechanism, efficacy, advantages, disadvantages, side effects, contraindications, and practical prescribing considerations.
UKMEC categories. The UK Medical Eligibility Criteria classify contraceptive methods against specific clinical conditions as Category 1 (no restriction), Category 2 (benefits outweigh risks), Category 3 (risks generally outweigh benefits), or Category 4 (unacceptable health risk). The OTA tests your ability to assign the correct UKMEC category for specific method-condition combinations. This is the area that generates the most questions and the most errors.
High-yield UKMEC scenarios: CHC in migraine with aura (Category 4), CHC in smokers over 35 (Category 3/4 depending on amount), CHC with BMI >35 (Category 3), IUD/IUS in current STI or PID (Category 4 for initiation), progestogen-only methods in breastfeeding (timing-dependent categories), and emergency contraception eligibility in various scenarios.
STI management. Chlamydia (doxycycline first-line), gonorrhoea (ceftriaxone IM + azithromycin), syphilis (benzathine penicillin), genital herpes (aciclovir), trichomoniasis (metronidazole), HIV testing and referral, partner notification principles, and STI screening in specific populations (under-25s, MSM, pregnancy).
Early pregnancy. Ectopic pregnancy recognition and referral, miscarriage management, pregnancy of unknown location, and the interaction between contraception and early pregnancy.
Cervical screening. NHS Cervical Screening Programme, HPV primary screening, management of abnormal results, and colposcopy referral criteria.
Safeguarding. Fraser guidelines, Gillick competence, under-16 consultations, vulnerable adults, and mandatory reporting.
How to Prepare
Use the iatroX DFSRH Q-Bank daily. 850+ questions mapped to the DFSRH curriculum with adaptive spaced repetition. The algorithm identifies whether your weakness is UKMEC, STIs, emergency contraception, or safeguarding — and targets it automatically. Start at least 6-8 weeks before your OTA sitting.
Learn the UKMEC summary table. The FSRH publishes the complete UKMEC table. Print it, study it, and test yourself on the high-yield Category 3 and 4 combinations. The iatroX Q-Bank includes UKMEC-specific questions that test exactly these scenarios.
Know the STI management algorithms. For each major STI: first-line treatment, test of cure requirements, partner notification, and management in pregnancy. Ask iatroX provides instant reference for STI management pathways.
Do the FSRH practice OTA. A practice assessment is available through the FSRH learning platform. Complete it under timed conditions to familiarise yourself with the question style.
Complete 200-300+ practice questions before sitting the OTA. The iatroX Q-Bank provides more than enough volume. The spaced repetition ensures retention — you will not forget the UKMEC categories you studied in week 2 by the time you sit the OTA in week 8.