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The Prescribing Safety Assessment — the open-book online prescribing test taken by every UK medical student and FY1 doctor. 60 items across 8 sections in 2 hours with full BNF, BNFc and NICE BNF access. Free 1,000+ question bank by UK prescribers mapped to the published British Pharmacological Society assessment framework.
Prescribing (8 items), Prescription review (8), Planning management (8), Providing information (6), Calculation skills (8), Adverse drug reactions (8), Drug monitoring (8), Data interpretation (6)
You have full access to the online BNF, BNFc and NICE BNF interaction checker throughout the exam. Skill in using these reference works under time pressure is examined as much as recall.
Delivered online via the Wiseflow platform (replacing earlier delivery systems). Hosted by individual medical schools for students; FY1 sittings are organised through deaneries.
Prescribing section carries the most weight (about 27% of marks) because items are worth more. Calculation skills, ADRs and prescription review are the next most heavily weighted.
Multiple sittings per year through individual medical schools for final-year students and through deaneries for FY1 resitters. UK medical students typically sit during the final year of medical school — a pass is required for full GMC registration. International medical graduates with eligibility may sit independent sittings. Confirm the 2026 sitting and booking dates on the official awarding-body page before booking.
The PSA examines prescribing across all 8 standardised sections. Clinical content draws from the entire BNF and BNFc with emphasis on common, important and high-risk medications.
Mapped to the eight published PSA domains and prioritised using item-density signals across the iatroX bank.
High-risk drug interactions — warfarin (food, antibiotics, NSAIDs, antiplatelets), lithium (NSAIDs, ACEi, thiazides, dehydration), methotrexate (NSAIDs, trimethoprim), MAOIs (tyramine, opioids), DOACs (P-gp/CYP3A4 inducers)
Renal dose adjustment — using eGFR thresholds to adjust dose for vancomycin, gentamicin, allopurinol, metformin (stop <30), DOACs (CrCl thresholds), NSAIDs
Calculations — paediatric weight-based dosing (mg/kg → ml of suspension), insulin infusion rate from prescription, methadone equivalents, parenteral conversion (oral to IV opioids), continuous infusion mcg/kg/min to ml/hr
Adverse drug reactions — Type A vs Type B vs Type C (chronic) vs Type D (delayed) vs Type E (end-of-treatment). Reporting via Yellow Card. Recognising common causative drugs (NSAIDs, antibiotics, anticonvulsants, antipsychotics)
Drug monitoring — vancomycin trough levels (target 15-20 for severe infection), gentamicin once-daily nomogram, lithium 12-hour level (target 0.6-1.0), warfarin INR targets per indication, digoxin levels (toxicity 1.5-3 mcg/L)
Prescription writing — controlled drug requirements (full name, address, age, total dose in words and figures, formulation, strength), pregnancy and breastfeeding categorisation, generic vs brand prescribing rules
Adverse drug reactions specific to FY1 prescribing — anaphylaxis recognition vs Type 1 hypersensitivity, drug-induced AKI, drug-induced QT prolongation, IV fluid prescribing errors
Discharge prescribing — TTAs (To Take Away), recognising omissions, dose adjustments at discharge (e.g. statin re-titration), counselling about new medications
Observations from UK medical students and FY1 doctors. Verify against the current BNF and NICE BNF.
Candidate-reported observations — not official guidance.
A pragmatic phased approach used by recent UK medical students passing the PSA first time.
A live item from the iatroX bank. Try it before launching a full session.
A 68-year-old man is admitted with an acute exacerbation of COPD. He has increased breathlessness and increased sputum volume and purulence. He is clinically stable, can take oral medicines, and has no radiographic evidence of pneumonia. He has no penicillin allergy, repeated recent antibiotic exposure or previous resistant sputum isolates. What is the most appropriate initial antibiotic?
Why iatroX is built differently for PSA.
Every iatroX item is tagged to a blueprint topic, so your performance dashboard mirrors the structure of the exam itself.
The engine surfaces your weakest topics first, in real time, instead of marching you through a static syllabus.
Incorrect items return at increasing intervals to interrupt the forgetting curve and lock knowledge into long-term memory.
Timed full-length simulations that mirror the official exam structure under realistic conditions.
The full PSA bank, adaptive engine, spaced repetition and AI performance dashboard — all free. Socratic tutoring is available with an iatroX subscription for supported quiz sessions.
Yes — the entire 1,000+ PSA bank is free at iatroX. No subscription is required for PSA, and it sits in the free tier alongside MRCP Part 1, MRCEM SBA and PARA. Paid exams such as UKMLA, PLAB 1, MSRA and MRCGP AKT include free sample questions, with full adaptive access with an iatroX subscription.
Final-year UK medical students sit the PSA before graduation as part of medical school finals. A pass is required for full GMC registration. FY1 doctors who failed the medical school sitting can resit through their deanery. International medical graduates with appropriate eligibility may also sit.
60 items across 8 sections, sat over 2 hours (120 minutes) online via the Wiseflow platform. Open-book — you have full access to BNF, BNFc and the NICE BNF interaction checker throughout. The Prescribing section carries the most weight (items worth more).
Criterion-referenced — set per cohort by panel review of item difficulty. Pass marks typically settle around 70% but vary by sitting. The aim is to identify the standard expected of a new FY1 prescriber.
Yes. Full BNF, BNFc and NICE BNF interaction checker access is built into the Wiseflow platform. However, you have only ~2 minutes per item — skill in rapid BNF lookup is itself a competency the PSA tests. Practise lookups under time pressure.
The PSA is a separate prescribing-specific assessment that is required for GMC registration. The UKMLA AKT is the broader knowledge test that is also required (or already integrated into medical school finals for UK students). Both must be passed.
No subscription is required for PSA content — it is in the iatroX free tier. UK medical students should have access without any payment.
Other iatroX hubs you may find useful.
see how iatroX compares to PassMedicine, Quesmed.
Reviewed by Dr Kola Tytler MBBS CertHE MBA MSt MRCGP · Last reviewed 12 May 2026
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