The PSA tests safe prescribing — a fundamental clinical competency that every doctor needs. The format is unique and requires specific preparation beyond general clinical revision.
Format
Eight question types: prescribing (write a complete prescription), dose calculation (weight-based, renal/hepatic adjustments), adverse drug reaction identification, drug monitoring (what to check and when), drug-drug interaction identification, communicating about medicines (patient counselling), data interpretation (blood results in medication context), and planning management (treatment plans). 60 questions in 2 hours. Crucially: BNF access is provided during the exam — but you need to know where to look quickly.
BNF Is Central
You have BNF access during the exam — this is an enormous advantage if you have practised navigating it under time pressure. The candidates who score well are not those who have memorised the BNF but those who can find the right information within 30 seconds. Practise: for any drug you encounter during revision, look it up in BNF. Check interactions. Check renal dosing. Check monitoring. Build the navigation reflex.
Prescribing Practice
The prescribing questions require you to write complete prescriptions — drug name (generic), dose, route, frequency, and duration. Missing any element loses marks. Practise writing prescriptions on paper or in the BNF prescribing format. Common errors: missing the route (IV vs oral), writing brand names instead of generic, incomplete dosing instructions, forgetting to specify duration for antibiotics.
High-Yield Interactions and ADRs
Know the commonly tested interactions: warfarin + antibiotics/NSAIDs, methotrexate + trimethoprim/NSAIDs, lithium + ACEi/NSAIDs/thiazides, phenytoin + many drugs (enzyme inducer), digoxin + amiodarone/verapamil. Know the commonly tested ADRs: statins (myopathy), ACEi (cough, angioedema), metformin (lactic acidosis, B12 deficiency), amiodarone (thyroid, pulmonary, hepatic, photosensitivity).
Time Management
60 questions in 2 hours = 2 minutes per question. The prescribing and calculation questions take longer — budget extra time for these and move faster through identification questions. Practise under timed conditions.