UK Prescribing Safety Assessment (PSA): The development, implementation and outcomes of a national online prescribing assessment.

The United Kingdom (UK) Prescribing Safety Assessment (PSA) is a 2-hour online assessment of prescribing competence. It has been undertaken by students and doctors in UK medical and foundation schools for the past decade. This study describes the academic characteristics and performance of the assessment; longitudinal performance of candidates and schools; stakeholder feedback; and surrogate markers of prescribing safety in UK healthcare practice. It demonstrates the feasibility, high-quality and reliability of an online prescribing assessment, uniquely providing a measure of prescribing competence against a national standard. Most candidates pass the PSA on their first attempt, while a minority are identified for further training and assessment. Most responders to a national survey agreed that the PSA is a useful instrument for assessing prescribing competence, and an independent review has recommended adding the PSA to the Medical Licensing Assessment. Surrogate markers suggest there has been improvement in prescribing safety in practice, temporally associated with the introduction of the PSA but other factors could be influential too. National systems should be developed to identify and report prescribing errors and the harm they cause, enabling the impact of educational interventions to be measured.