You have covered DFSRH when you can show, not assume, that every domain in the Faculty's diploma curriculum has been practised on unseen questions, at exam pace, with your errors coded by cause and your guideline sources dated. That is a checklist, not a study timetable. This article is written for clinicians preparing for the knowledge gate — the eKA (electronic Knowledge Assessment) that opens the door to the diploma — and it deliberately stops short of the e-learning, the Course of Study and the supervised clinical experience that the full award also requires. The single most common mistake is to stop doing new questions because a percentage looked reassuring, when the real question is whether any domain is still hidden.
A naming and format note before you start. The Faculty of Sexual & Reproductive Healthcare (FSRH) became the College of Sexual & Reproductive Healthcare (CoSRH) with effect from August 2025, and fsrh.org now redirects to cosrh.org. In the same period the diploma has been redesigned and is increasingly referred to as the DCSRH (Diploma of the College of Sexual & Reproductive Healthcare) rather than the DFSRH. CoSRH materials also refer variously to an electronic Knowledge Assessment (eKA) and to an Online Theory Assessment (OTA). Because the naming and the exact assessment specifics are in transition, treat every format figure below as a planning estimate and verify the current name, question count, duration and pass rule for your diet directly on cosrh.org before you rely on it. Throughout this article DFSRH and DCSRH refer to the same qualification.
What "covered" means for the DFSRH knowledge gate
For a knowledge-gate exam, "covered" is not a feeling and it is not a completion figure. It is a set of statements you can defend with evidence. Before you stop doing new questions, you should be able to say all of the following and point to the data behind each one:
- Every domain in the diploma curriculum has been sampled on unseen questions, not just the ones you enjoy.
- Your first-attempt accuracy on unseen items is stable across a recent, timed, mixed block — not lifted by a familiar topic filter.
- You have no domain sitting below a defensible floor (a level at which a bad run of the blueprint could sink you).
- Your guidance-sensitive facts trace to a source you have dated — UKMEC 2025, current FSRH Clinical Effectiveness Unit (CEU) guidance, and the relevant Summary of Product Characteristics (SmPC) via the electronic Medicines Compendium (eMC).
- Your high-confidence errors — the ones you got wrong while feeling sure — are close to zero.
- You can hold exam pace (roughly 100 items in up to two hours, near enough one minute per question) without your accuracy collapsing in the final quarter.
If you cannot yet say those things, a reassuring percentage is telling you about the questions you chose to answer, not about the exam — and the rest of this article turns each statement into a check you can run.
Current exam snapshot
The knowledge gate is the eKA. Per the College's published format and the standing exam specification, it is structured as 100 single-best-answer questions, five options each, delivered by computer over up to two hours, with no negative marking and an immediate pass/fail result that carries no score breakdown. There is no domain-by-domain feedback — you are told pass or fail on screen and nothing more. That is why a content-gap checklist matters: the exam will not tell you which domain let you down, so you have to know before you sit it.
The eKA is only the knowledge component. The full diploma also requires the e-SRH e-learning programme (produced by elearning for Healthcare with the College), a Course of Study, and supervised clinical experience signed off by a registered trainer. A question bank — including iatroX — can rehearse the knowledge the eKA samples and can measure it on unseen items. It cannot deliver your clinical experience, your practical competences, or your trainer sign-off. Keep that boundary in mind: this checklist audits the knowledge layer only.
The authoritative curriculum and resource list live on cosrh.org (Education and Training) and in the e-SRH programme on e-LfH. Where medicines detail matters — contraceptive and HRT products in particular — the reference is the SmPC on the eMC, sitting alongside UKMEC 2025 for eligibility and FSRH/CEU guidance for management. UKMEC 2025 supersedes the 2016 and 2019 editions; if you learned eligibility categories from an older edition, that is a recency gap in its own right.
Build a blueprint coverage table
The core instrument of a content-gap audit is a table that puts your self-selected practice next to the curriculum. Because the College does not publish fixed per-topic percentage weights for the eKA, do not invent them — record a qualitative emphasis (High / Medium / Low) drawn from the curriculum and the e-SRH structure, clearly as a planning estimate, and let the measured columns do the real work.
| Domain | Curriculum emphasis (verify on cosrh.org) | Questions attempted (unseen) | First-attempt accuracy | Last reviewed | Confidence (H/M/L) |
|---|---|---|---|---|---|
| Combined hormonal contraception (CHC) & VTE/CVD risk | High | ||||
| Progestogen-only pills, injectables, implant | High | ||||
| Intrauterine contraception (Cu-IUD & LNG-IUS) | High | ||||
| Emergency contraception | High | ||||
| UKMEC 2025 application to comorbidity | High | ||||
| Drug interactions & enzyme inducers | Medium | ||||
| STIs, partner notification, sexual health | Medium | ||||
| Early pregnancy, unscheduled bleeding, abortion referral | Medium | ||||
| Cervical screening pathways | Medium | ||||
| Consent, confidentiality, safeguarding, law/ethics | Medium | ||||
| Menopause/HRT-adjacent counselling & stopping contraception | Low–Medium | ||||
| Special populations (young people, postpartum, learning disability) | Low–Medium |
Fill the measured columns from your bank's analytics, not from memory. The row that matters is not your best row; it is any row where "questions attempted" is small, "last reviewed" is old, or confidence is low while accuracy is untested. Those are your content gaps, and they are invisible in an overall percentage.
The ten domain-level blind spots most likely to stay hidden
Self-selected practice hides the topics you avoid and flatters the topics you repeat. In sexual and reproductive healthcare, these ten are the ones that most often remain untested until the exam finds them. Each should have deliberate, exam-specific clinician review before you conclude it is safe.
- UKMEC 2025 category changes versus the 2016/2019 categories you may have first learned — the category for a given comorbidity-and-method pairing is exactly the sort of fact that moves between editions.
- Emergency contraception decision-making — choosing between ulipristal acetate, levonorgestrel and the copper IUD by timing and circumstance, the interaction between ulipristal and subsequently started hormonal methods, and when quick-starting is appropriate.
- Enzyme-inducing drug interactions and their effect on contraceptive efficacy — which methods are affected, and the correct advice for short-course versus long-term inducers.
- Missed-pill, late-injection and out-of-window rules — the precise thresholds and the bridging/emergency-contraception advice that follows, method by method.
- Safeguarding, Fraser guidelines and Gillick competence — confidentiality and consent for under-16s and the specific concerns triggered by under-13 disclosure.
- Quick-starting and switching methods — when additional precautions are needed and for how long, and how to bridge safely between methods.
- VTE and cardiovascular risk assessment for CHC — the combination of migraine with aura, BMI, age, smoking, blood pressure and postpartum timing, and how those map to eligibility.
- Problematic and unscheduled bleeding on progestogen methods — when it is expected, how to manage it, and the threshold for investigation or referral.
- Cervical screening pathways — HPV primary screening logic and the management of results as they present in an SRH setting.
- Contraception around the menopause and HRT-adjacent counselling — when contraception can stop, and the clear line that HRT is not contraception.
None of these should be signed off on the basis of "I've seen questions on it." They should be signed off on the basis of unseen questions answered correctly, at pace, with the reasoning traced to a current source.
Format checklist: deliberate practice for recency, counselling and competence
The eKA is single-best-answer knowledge, but the knowledge it tests has three textures you should have practised deliberately.
- FSRH/UKMEC recency. For every eligibility or management fact, can you name the source and its edition? UKMEC 2025 and current CEU guidance are the anchors. Practising on questions written against an older edition is a quiet way to bank the wrong answer.
- Counselling and communication. Many stems test what you would advise or say, not just what is true — the safe, patient-centred next step. Make sure your practice includes these, not only mechanism-of-action recall.
- Practical competence — know the boundary. The eKA does not assess practical competence; that is what supervised clinical experience and the letters of competence are for. Do not spend eKA preparation trying to rehearse a procedure the knowledge exam will not test — but do make sure you can answer the knowledge that surrounds it.
Interpretation checklist
"Interpretation" on an SRH knowledge exam is not ECGs and chest radiographs. Be honest about what the eKA actually asks you to interpret:
- Dates, timing windows and thresholds — the closest thing to a "calculation" here: emergency-contraception timing, pregnancy dating, quick-start windows, injection intervals, and the numeric thresholds (blood pressure, BMI, age) that drive eligibility.
- Eligibility-category application — reading a clinical picture and returning the correct UKMEC 2025 category is the exam's signature interpretive task.
- Ethics, consent and confidentiality — applying Fraser/Gillick logic and safeguarding thresholds to a described scenario.
- Basic laboratory and screening results as they arise in SRH — a screening result, a pregnancy test in context — rather than complex trend interpretation.
If your bank is drowning you in image and tracing interpretation, it is probably mis-blueprinted for this exam.
Recency checklist
For each guidance-sensitive topic, record the source and its date, and note the jurisdiction. Guidance-sensitive topics for DFSRH include: UKMEC 2025 eligibility categories; current CEU guidance on each contraceptive method; emergency contraception; drug interactions; unscheduled bleeding; and cervical screening (which is organised at national level, so confirm the UK nation your material describes). A fact without a dated source is a fact you cannot defend in July 2026. Where a product detail is involved — dose, contraindication, licensed indication — trace it to the SmPC on the eMC rather than to a revision note.
Performance checklist
Coverage without performance is a false negative waiting to happen. Before you stop, confirm:
- Unseen, timed, mixed blocks. Your readiness signal comes from questions you have not seen, delivered mixed (not topic-filtered), under the clock.
- Speed. You can sustain roughly one minute and a little per item across a full-length block without accuracy falling away at the end.
- High-confidence errors near zero. Track the items you got wrong while certain — these are the dangerous ones, and they should be disappearing.
- Retention. A domain you "fixed" three weeks ago is still correct today, tested cold.
- Official-material calibration. Whatever official or specimen material CoSRH provides has been sat under exam conditions, once, and your third-party performance is broadly consistent with it.
Stop / continue decision tree
Use the measured gap, not novelty or how many questions remain in the bank, to choose the next action.
- Continue new questions if any domain is under-sampled or below its floor on unseen items. You have a coverage gap; close it.
- Consolidate (stop new, review misses) if coverage is broad but the same error codes keep recurring. You have a retention or reasoning gap, not a coverage gap; more new questions will not fix it.
- Simulate if coverage and accuracy are solid but you have never done a full-length, timed, mixed sitting. You have a stamina/pacing gap; rehearse the whole thing once.
- Seek teaching if one domain resists every attempt — bring it to a trainer or a study group. Some gaps are conceptual and need a person, not a bank.
- Rest if accuracy is high, coverage is complete, and your errors are now careless rather than knowledge-based. More questions past this point mostly add fatigue.
The one-page checklist (copy this)
- Every curriculum domain sampled on unseen questions — no empty rows in the coverage table.
- No domain below its floor on a recent timed mixed block.
- The ten blind spots each signed off on unseen items, not on "I've seen it".
- Every guidance-sensitive fact traced to UKMEC 2025 / current CEU guidance / SmPC, with a date.
- High-confidence errors tracked and near zero.
- At least one full-length, timed, mixed sitting completed.
- Current assessment name and format re-checked on cosrh.org for your diet.
- Overall percentage explicitly set aside in favour of the measures above.
Worked example (invented data)
Priya, a GP registrar, has completed 780 questions across two banks and sits at 71% overall. Reassured, she is ready to stop. Her coverage table tells a different story. Contraception rows are full and strong: CHC 84% first-attempt accuracy over 120 unseen items, intrauterine contraception 79% over 60. But three rows are nearly empty: emergency contraception has 14 attempts at 57%, UKMEC application 22 attempts at 55%, and safeguarding/consent just 9 attempts, last reviewed six weeks ago. Her 71% is real, but it is an average of strong contraception knowledge and untested weak spots.
Her decision tree output is not "stop". It is "continue new questions" for the three thin rows, and specifically unseen items — because repeating the ones she has seen would inflate the number without closing the gap. She runs a fresh, timed, mixed block of 50 unseen questions, holds pace, and finds her emergency-contraception accuracy is genuinely 60%. She codes the misses: most trace to UKMEC 2025 categories she first learned from an older edition — a recency gap with a single fix. Two weeks later, having reviewed against UKMEC 2025 and retested cold, all three rows clear their floor, high-confidence errors are down, and her decision tree finally reads "simulate, then rest". Notice what did the work: the table and the error codes, not the 71%.
Frequently asked questions
How do I know whether I have covered the full DFSRH blueprint? You know when your coverage table has no empty or thin rows and no domain sits below its floor on a recent, timed, mixed block of unseen questions — with the ten common blind spots each signed off on unseen items rather than on familiarity. Because the eKA returns only pass or fail with no score breakdown, the exam will never confirm coverage for you; you have to demonstrate it in advance against the curriculum published on cosrh.org. Completion of a bank is not the same as coverage of the blueprint.
Can one question bank be enough for DFSRH? One bank can be enough to learn from, but it is rarely enough to prove readiness, because every bank has its own blind spots and its own house style, and once you have seen its questions they can no longer measure you. The more robust approach is to use one bank as your main teaching source and keep a second, genuinely unseen bank in reserve purely for timed measurement — the two-Q-bank rule. That is precisely the role iatroX is designed to play alongside PasSRH or the official material: the unseen-measurement layer, not a replacement teacher.
What should I measure instead of my overall Q-bank percentage for DFSRH? Measure per-domain first-attempt accuracy on unseen items, the size of your sample in each domain, your high-confidence error rate, your pace across a full-length block, and your retention of previously fixed topics. An overall percentage blends strong and weak domains into one comforting number and hides exactly the gaps that can fail you; the domain-level and unseen-item measures do the opposite. Our standing note on why your Q-bank percentage is not your exam score sets this out in full.
When should I stop doing new DFSRH questions? Stop doing new questions when no domain is under-sampled or below its floor, your high-confidence errors are near zero, and your remaining mistakes are careless rather than knowledge-based — at which point the decision tree points to consolidate, simulate or rest, not continue. Stopping because a percentage looked good, or because you were bored, or because you finished the bank, is stopping on the wrong signal. The measured gap decides, not the completion bar.
Which DFSRH resource should I use for my weakest component? Match the resource to the type of weakness. If the weakness is knowledge coverage, a question bank (PasSRH or iatroX) closes it; if it is understanding of a concept, the e-SRH e-learning and current CEU guidance are the right first stop; if it is practical competence, only supervised clinical experience with your trainer will do, and no bank substitutes for it. Diagnose the weakness first — coverage, concept or competence — and then choose, rather than defaulting to more questions for a problem that questions cannot solve.
Editorial notes and references
Written by Dr Kolawole Tytler, NHS GP and founder of iatroX. Last checked 21 July 2026. Exam-format figures for the eKA reflect the standing specification and the College's published description; because the Faculty rebranded to the College of Sexual & Reproductive Healthcare (CoSRH) in August 2025 and the diploma has been redesigned (DFSRH → DCSRH), verify the current assessment name, question count, duration and pass rule on cosrh.org before relying on any figure here. Any vendor-reported detail is labelled as such and dated 21 July 2026; product counts and prices change, so confirm them on the product page.
Disclosure: iatroX operates a UK question bank that competes with the products discussed here. Its role in this article is confined to the job the official pathway does not claim to do — supplying unseen, timed questions for measurement of the eKA knowledge layer. iatroX does not provide the e-SRH e-learning, the Course of Study or the supervised clinical experience, and it is not a substitute for them. Corrections are welcome via the feedback route on iatrox.com.
References: College of Sexual & Reproductive Healthcare — Education and Training and eKA pages, cosrh.org (formerly fsrh.org); UKMEC 2025 (CoSRH); FSRH Clinical Effectiveness Unit guidance; Sexual and Reproductive Healthcare (e-SRH), elearning for Healthcare, e-lfh.org.uk; medicines detail via SmPC on the eMC. Internal: Your Q-Bank Percentage Is Not Your Exam Score; the two-Q-bank rule; question-bank completion is not coverage; the iatroX DFSRH question bank and comparison hub.