A question bank can get you through the DFSRH electronic Knowledge Assessment (eKA), and for that single component it is the right tool. What it cannot do is prepare you for the parts of the diploma that decide whether you are actually safe to provide contraception: keeping pace with FSRH and UKMEC guidance as it changes, counselling a real person through a method decision, and demonstrating competence in supervised clinical practice. Those are performance skills, not recall, and this article sets out what each one requires and how to train it deliberately.
One housekeeping point first, because the name is mid-transition. The Faculty of Sexual & Reproductive Healthcare (FSRH) has become the College of Sexual and Reproductive Healthcare (CoSRH), and the diploma is being renamed from DFSRH to DCSRH; fsrh.org now redirects to cosrh.org. The qualification, the pathway and the eKA are the same. If you land on a page badged DCSRH or CoSRH you are in the right place — verify the current name and fee before you pay.
The official format map: where the eKA sits in the whole diploma
The eKA is one component, not the diploma. Read the pathway in full and the modality gap becomes obvious:
- e-SRH e-learning — the FSRH/CoSRH online modules that carry the knowledge base.
- A Course of Study — the taught element.
- The eKA — the knowledge gate: 100 single-best-answer questions, five options each, up to two hours, computer-based, no negative marking, with an immediate pass/fail decision and no score breakdown (last checked 21 July 2026).
- Supervised Clinical Experience — observed practice signed off by a registered trainer, where competence is actually demonstrated.
Only one of those four is an MCQ, and it returns pass or fail with no domain feedback. Everything a bank optimises for lives in that single box. The blueprint behind the eKA is contraception-weighted: the main methods and their UK Medical Eligibility Criteria (UKMEC), emergency contraception, sexually transmitted infection and vaginal-discharge assessment, asymptomatic STI screening, HIV testing, and the assessment and onward management of unplanned pregnancy, with consent, confidentiality and safeguarding running throughout. Because this is contraception and hormonal prescribing, your factual sources are the Summary of Product Characteristics on the eMC for individual products, sitting under FSRH/CoSRH clinical guidance, UKMEC 2025 and NICE CKS — not a formulary handbook.
Separate what a correct answer proves from what it does not
A correct eKA answer proves one thing: at that moment, presented with a tidy stem and five options, you could recognise the best one. That is genuinely necessary — you cannot counsel safely on knowledge you do not hold. But it does not prove you can elicit the relevant history from a nervous 19-year-old who has not mentioned the migraine with aura that changes everything; it does not prove you can hold a shared decision when the patient wants the method your UKMEC assessment counsels against; and it does not prove you can perform, or safely defer, a procedure. The selected-response format quietly supplies the very things clinical practice withholds: the salient facts are pre-extracted, the options are bounded, and one answer is definitely right. Real consultations offer none of that scaffolding.
The three things the eKA under-tests — and how to train each
Skill one: FSRH/UKMEC recency
Contraceptive guidance is a moving target. UKMEC 2025 now supersedes the 2016 edition and its 2019 amendment, and the FSRH/CoSRH Clinical Effectiveness Unit revises method-specific guidance regularly. A bank is, by construction, a snapshot: it was written on a date and it decays from that date. An item drilled last year may test a threshold that has since moved. The recency skill is knowing which edition governs the answer today and being able to name the change.
The observable behaviour is that, given a scenario, you can state the current UKMEC category and say whether it changed in 2025. The deliberate-practice task is a fortnightly "diff" habit: read the UKMEC 2025 summary of key changes and the CoSRH guidance-update feed, and for each change write the old position, the new position and the patient it affects. The feedback source is the primary document itself — UKMEC 2025 and the named FSRH/CoSRH guideline, never a secondary crib. The exit standard is that you can take any method and correctly state its current UKMEC categories for the common conditions (migraine with aura, VTE history, breastfeeding timing, BMI, age) from memory, and flag where 2025 differs from what an older bank taught.
Skill two: counselling and shared decision-making
The eKA can ask which method is most appropriate; it cannot watch you help a person choose. Counselling is the skill of surfacing what matters to this patient — bleeding pattern, reversibility, needle aversion, what a partner may or may not be told — and holding an honest, non-directive conversation about effectiveness, risks and alternatives, including the option of no method. It is the core of the supervised clinical experience, and it is where most real safety lives.
The observable behaviour is a consultation in which you elicit the patient's priorities, present options in plain language with accurate effectiveness figures, check understanding, and document a genuinely shared decision. The deliberate-practice task is role-played and then real consultations against a structured checklist — ideas/concerns/expectations, UKMEC-relevant history, method-neutral information-giving, safety-netting. The feedback source must be a person: your registered DFSRH trainer or an experienced SRH clinician observing and debriefing, because the quality being judged is interpersonal and cannot be scored from a transcript. The exit standard is your trainer's sign-off that you counsel unprompted, safely and non-directively across the common scenarios.
Skill three: practical clinical competence
Competence in the DFSRH sense is demonstrated in supervised practice: assessing a real patient's eligibility, providing or safely initiating a method, recognising when to refer, and managing the follow-up. Procedural competence for intrauterine and subdermal methods sits beyond the core diploma, in the separate FSRH Letters of Competence, but even the core diploma is assessed by observed clinical work, not by MCQ. No amount of question practice substitutes for a trainer watching you take a history, apply UKMEC to a live patient and act on it.
The observable behaviour is safe, independent-standard performance across supervised consultations, with correct escalation when a case exceeds your competence. The deliberate-practice task is logged, supervised clinical sessions with a registered trainer, deliberately spanning the range of methods and presentations rather than the same easy repeat prescriptions. The feedback source is, again, the trainer — direct observation and structured debrief. The exit standard is the trainer's competence sign-off required to complete the diploma. iatroX and any bank are silent here by design: they are knowledge tools, not a substitute for the clinical experience.
| Under-tested skill | Observable behaviour | Deliberate-practice task | Feedback source | Exit standard |
|---|---|---|---|---|
| FSRH/UKMEC recency | States current UKMEC category and whether 2025 changed it | Fortnightly guideline "diff": old vs new vs affected patient | UKMEC 2025 and named FSRH/CoSRH guidance (primary) | Recites current categories from memory; flags 2025 changes |
| Counselling / shared decision | Elicits priorities, gives balanced options, documents shared decision | Checklist-driven role-play then real consultations | Registered trainer / SRH clinician debrief | Trainer sign-off: safe, non-directive, unprompted |
| Practical clinical competence | Safe supervised performance; correct escalation | Logged supervised sessions across methods | Registered trainer, direct observation | Diploma competence sign-off |
A four-week modality ladder
Skills like these are trained by climbing from isolated drill to unseen performance, not by grinding one rung. A four-week ladder, adapted to your diet date:
- Week 1 — isolated skill. Drill each element alone: a UKMEC-recency block; a counselling micro-skill (information-giving on one method); a single history-taking domain. Keep the eKA bank running in the background for knowledge, but treat these as separate reps.
- Week 2 — coached case. Combine the elements in a role-played or supervised consultation with a trainer present, stopping to debrief. The coaching is the point; you are calibrating against an expert in real time.
- Week 3 — timed integrated case. Run full consultations at realistic pace without stopping, then debrief afterwards. This exposes whether the skill holds under time pressure, which isolated drill never reveals.
- Week 4 — unseen simulation. Face fresh scenarios you have not rehearsed — a new UKMEC edge case, an unfamiliar counselling dilemma — under observation. Performance on the unseen case, not the rehearsed one, is the readiness signal.
Interleave an unseen eKA-style block across all four weeks so the knowledge layer is measured on items you have never met, not on questions you have memorised.
When AI feedback helps, when it misleads, and when only a clinician will do
Automated feedback has a real but bounded role here, and it is worth being precise about the boundary — the fuller argument is in the pillar on calibrating AI-graded feedback. AI is useful for the knowledge layer: generating unseen practice stems, explaining why a distractor is wrong, and surfacing a UKMEC threshold you had forgotten. It is unreliable the moment the task becomes performance — grading the warmth and clarity of a counselling exchange, judging whether a shared decision was genuinely shared, or confirming that a history was safe. A model can score a transcript for keywords; it cannot see that you talked over the patient's hesitation. And it is no substitute at all for the parts the diploma reserves for a human: the trainer's observation of live clinical practice and the competence sign-off. Use AI to keep the knowledge sharp; use a clinician-examiner to judge whether you are safe.
Build a balanced case matrix so you do not rehearse only the familiar
Candidates gravitate to the scenarios they find comfortable and quietly avoid the ones they do not, which is how a confident candidate arrives underprepared for exactly the case that catches them. Build a deliberate matrix and force coverage across it: methods (combined hormonal, progestogen-only pill, injectable, implant, intrauterine, barrier, emergency contraception, fertility awareness) crossed against complicating factors (migraine with aura, VTE risk, postpartum and breastfeeding, perimenopause, safeguarding concern, contraindication requiring referral). Track which cells you have actually practised as counselling or supervised cases — not just read about — and steer your remaining sessions toward the empty cells. This is the same completion-versus-coverage discipline that governs question banks: coverage of the map, not volume within your comfort zone.
Red flags that you are training recognition, not competence
Watch for the tells that your preparation has drifted into memorising performances rather than building skill: memorised scripts you deliver identically regardless of the patient in front of you; repeated cases you have effectively learned by heart, so your fluency is recall not reasoning; generic feedback ("good consultation") that names no specific behaviour to change; uncalibrated scoring, whether a bank percentage or an AI grade, that you cannot map to any official standard; and no official-rubric check, meaning you have never held your counselling or clinical work against the FSRH/CoSRH competence framework. Any one of these means you are rehearsing familiarity. The fix in every case is an unseen case judged by a person against the real rubric.
Frequently asked questions
How do I know whether I have covered the full DFSRH blueprint? Map your practice against the published eKA subject areas — the main contraceptive methods and their UKMEC categories, emergency contraception, STI and vaginal-discharge assessment, asymptomatic screening, HIV testing, unplanned-pregnancy assessment, and the consent, confidentiality and safeguarding themes — and tick a domain only when you have both answered unseen questions on it and, for the clinical elements, practised it under supervision. Coverage is a map of the blueprint you can evidence, not the number of questions you have completed; the completion-is-not-coverage method sets out how to build that matrix.
Can one question bank be enough for DFSRH? For the eKA knowledge gate, a single good bank can be sufficient, provided it is current to UKMEC 2025 and you measure yourself on unseen items rather than on your review of the same questions. For the diploma as a whole, no bank is ever enough, because the Course of Study and the supervised Clinical Experience are mandatory, human-assessed components that no MCQ product reproduces. Passing the eKA is necessary and nowhere near sufficient.
What should I measure instead of my overall Q-bank percentage for DFSRH? Measure three things the percentage hides: your score on unseen, timed eKA-style blocks (the transfer signal); your accuracy on current UKMEC 2025 categories specifically, separated from older items; and, for the clinical side, your trainer's structured feedback across a balanced case matrix. A single blended percentage flatters you by averaging strong recall over weak recency and untested performance — which is exactly why your bank percentage is not your exam score.
When should I stop doing new DFSRH questions? Stop adding new eKA questions when your unseen timed blocks sit consistently at your target, the same distractors no longer catch you, and your errors have shifted from knowledge gaps to occasional slips. At that point marginal questions add little, and your remaining time is better spent on the components a bank cannot touch: supervised consultations, UKMEC-recency drills and counselling practice. More questions past that point is comfort, not progress.
Which DFSRH resource should I use for my weakest component? Match the resource to the modality of the weakness. If the gap is knowledge or recency, use a current bank plus the UKMEC 2025 and FSRH/CoSRH primary documents. If it is counselling, use supervised and role-played consultations with a clinician's debrief. If it is practical competence, use logged clinical sessions with your registered trainer — and, for intrauterine or subdermal procedures specifically, the separate FSRH Letters of Competence pathway. The wrong move is to answer more MCQs in the hope they fix a performance gap they cannot reach.
Editorial notes and references
Written by Dr Kolawole Tytler, NHS GP and founder of iatroX. Last checked 21 July 2026. The FSRH-to-CoSRH and DFSRH-to-DCSRH transition is live, so confirm the current name, fee and regulations on cosrh.org before you rely on them; UKMEC 2025 supersedes the 2016 edition and 2019 amendment. Disclosure: iatroX operates a UK question bank that competes with commercial eKA banks; this article confines iatroX to the unseen knowledge-measurement job and states plainly that it does not reproduce the Course of Study, the supervised Clinical Experience, or the counselling and competence sign-offs that only a registered trainer can give. Corrections are welcome via the feedback route on iatrox.com.
References: College of Sexual and Reproductive Healthcare (formerly FSRH) diploma pathway, eKA guidance and Clinical Effectiveness Unit guidance, cosrh.org; UKMEC 2025 and its summary of key changes, cosrh.org; NICE CKS contraception topics and the SmPC/eMC for product detail; "Your Q-Bank Percentage Is Not Your Exam Score," iatrox.com/blog/qbank-percentage-not-your-exam-score; "Calibrating AI-graded SAQs and OSCEs," iatrox.com/blog/ai-graded-saqs-and-osces-how-to-calibrate-automated-feedback-before-you-trust-the-score; "Question-bank completion is not coverage," iatrox.com/blog/question-bank-completion-is-not-coverage-how-to-build-a-blueprint-coverage-matrix-for-any-medical-exam; iatroX comparison hub, iatrox.com/compare.